Analytical Study of a Case Series of Vancomycin Associated Adverse Drug Reactions in Paediatric Population at a Tertiary Care Hospital: A Brief Report

Red man syndrome (RMS) is frequently reported from pediatric ward in patients receiving vancomycin, at the medical store of SGH, Pune. Though common in pediatric patients, not all patients receiving vancomycin developed Red man syndrome. Hence, this study was done to analyse the demographic, pathophysiological, and pharmacological aspects of the subject who experience adverse drug reactions with vancomycin and to determine if this predisposition is associated with any of these factors.

All adverse drug reactions (ADR) to injection vancomycin in the pediatric ward that were reported from April 2018 - January 2022 were included. Controls were a similar number of randomly selected pediatric cases from the same ward who had received Intravenous vancomycin during the same period but did not experience the adverse drug reactions

The mean age was 29.91 ± 34.87 months in subjects who experienced ADR and 57.37 ± 41.58 months, in non-ADR group (p=0.0286). 37.4% were infants, 29.69% toddlers in ADR Group. Seventy four percent of patients who manifested with ADR were below age of 3 compared to barely 38% in controls (p=0.03). 66.6% were malnourished in the ADR group compared to 27.6% in controls (p=0.007). There was no association between the ADR and ethnicity, religion, gender, diagnosis, co-morbidities, co-administered drugs, or administered dose of vancomycin among the children. There was no apparent seasonal variation in occurrence of the ADR.

TRMS is more common in paediatric population than adults and is usually uneventful. Around 75% of the reactions occur within first 4 days of start of Vancomycin and usually occurs within 30 min of the preceding dose. Younger age groups (infants) and malnourishment were the two factors significantly associated with occurrence of RMS. We may also consider using lower than conventional doses and much slower infusions in such at-risk population.