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A nurse was hospitalized for abdominal surgery. Because she had a history of mitral valve prolapse, her doctor ordered I.V. vancomycin and gentamicin preoperatively to prevent endocarditis.
The patient also had a history of drug allergies, so she was somewhat apprehensive when her nurse started the infusion and left the room. Within minutes, she became even more apprehensive, but she attributed this to her concern about the upcoming surgery. When she felt a hot flush on her face and neck, however, she thought she was having an allergic reaction.
She quickly shut off the infusion and called her nurse. By the time the nurse arrived, the patient's face and neck had swollen; her scalp itched; and her arms, chest, and thighs were red and covered with hives. The patient's nurse called the doctor, who ordered 50 mg of diphenhydramine, which relieved the symptoms almost immediately. Since the patient didn't develop any respiratory or cardiovascular reactions, the surgery was performed on schedule.
Any antibiotic, especially one that's administered I.V. has the potential for causing an allergic reaction. But vancomycin has been known to cause a severe rash (the "red neck syndrome") and prolonged hypotension, which is not an allergy but is related to the speed of the administration. Vancomycin I.V. must be given over at least 1 hour. Stay for at least 5 minutes with a patient who's receiving any I.V. antibiotic for the first time, and monitor her closely throughout the infusion. Even a patient who has no history of drug allergies may unexpectedly develop a reaction.