title: Vancomycin hypersensitivity: synergism with narcotics and "desensitization" by a rapid continuous intravenous protocol.
abstract: BACKGROUND
  We examined the clinical spectrum of patients with persistent adverse reactions to vancomycin, assessed contributing factors, and evaluated the efficacy and safety of a rapid continuous intravenous "desensitization" protocol in these patients.
  
  
  METHODS
  Seven patients with serious staphylococcal infections resistant to beta-lactam antibiotics whose adverse reactions to vancomycin persisted despite slowing of the vancomycin infusion and pretreatment with H1-antihistamine were studied. All seven patients underwent a rapid continuous intravenous desensitization protocol with multiple small increases in vancomycin concentration tightly regulated with a syringe pump.
  
  
  RESULTS
  Most of the seven patients safely achieved, during the first day, a vancomycin infusion rate (VIR) sufficient, or close to sufficient, to provide the desired vancomycin dose. In three patients there appeared to be a threshold VIR beyond which adverse reactions were repeatedly elicited; these reactions abated when the VIR was slightly lowered. Narcotic administration was found to adversely affect treatment with vancomycin. After concurrent narcotic administration was discontinued in three patients, they and the other four patients successfully completed the full course of treatment with vancomycin.
  
  
  CONCLUSIONS
  Patients whose adverse reactions to vancomycin did not respond to slowing of the infusion rate and additional H1-antihistamines can be safely treated with a rapid continuous intravenous desensitization protocol and discontinuance of narcotic administration.
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: J T
authors.initials: JT
authors.lastname: Wong
authors.forename: R E
authors.initials: RE
authors.lastname: Ripple
authors.forename: J A
authors.initials: JA
authors.lastname: MacLean
authors.forename: D R
authors.initials: DR
authors.lastname: Marks
authors.forename: K J
authors.initials: KJ
authors.lastname: Bloch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000517:prevention & control*; D004357:Drug Synergism; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000188:drug therapy; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D006634:Histamine H1 Antagonists; D009294:Narcotics; D014640:Vancomycin