1. Student answer 2 pharm
Description of the patient case: The patient is a 26-year-old Male, who presented to our ER
for worsening right elbow bursitis. The patient was seen in the ER 2 days prior for the same
issue, underwent a drainage procedure with documented removal of only 1cc, and was
started on PO Keflex. Fluid was also sent for culture. Since the last time in the ER, the patient
reported worsening pain and spreading redness around the elbow. The patient also
reported some intermittent numbness and tingling in the fingers of the right hand. The
patient decided to come back in due to concerns about a possible worsening infection. The
patient denied any fevers/chills or other systemic symptoms. The patient denied tobacco or
alcohol use. Factors that might have influenced the pharmacokinetic and pharmacodynamic
processes of the patientThe patient was not responding to the trial of oral
antibiotics. Keflex 500mg PO QID instructed to take one tablet by mouth four times a day
for 5 days. Once inpatient, the patient was started on IV vancomycin. Following the initial
dose of Vancomycin 1.5gm IV loading dose, he had a mild vancomycin infusion reaction with
a pruritic rash on the abdomen that resolved with PO Benadryl dose. Following doses of
vancomycin were tolerated better with Benadryl pre-treatment and slowing infusion
rate.One factor to consider in this case was the rate of the IV infusion. “Red Man Syndrome”
is used to describe the adverse effect of vancomycin infusion. This anaphylactoid reaction is
caused by vancomycin degranulation of mast cells and basophils resulting in histamine
release independent of IgE (Rivera & Ryan, 2022). Another factor that may be worth noting
is gender. According to Alvarez-Arango et al. (2021), White patients were found more likely
to experience Red Man Syndrome than non-White patients. Red Man Syndrome was also
identified as more likely to affect male rather than female patients (Alvarez-Arango et al.,
2021). A personalized plan of careAccording to Rosenthal & Burchum (2021), one patient
may experience adverse effects from a medication, while others may not. Asking the patient
to report symptoms during and after the initiation of medication can help with identifying
adverse reactions and implementing a plan to treat symptoms. In assessing the risk-to-
benefit ratio of medication, one must consider the severity of the side effects (Rosenthal &
Burchum, 2021). In this case, vancomycin 1gm IV q12hrs (15mg/kg dosing) was
continued. The infusion rate was extended to 120 minutes. The patient was also pretreated
with Benadryl 50mg by mouth to prevent infusion
reaction. References:Alvarez-Arango,
S., Michelle, O. S., Sequist, T. D., & Burk, C. M. (2021). Vancomycin infusion reaction —
moving beyond “Red man syndrome”. The New England Journal of Medicine, 384(14), 1283-
2. 1286. doi:https://doi.org/10.1056/NEJMp2031891Rivera, C. G., & Ryan, K. L. (2022). Call to
Pharmacists: End Use of “Red Man Syndrome.” Annals of Pharmacotherapy, 56(1), 102–
103. https://doi.org/10.1177/10600280211021417Rosenthal, L. D., & Burchum, J. R.
(2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician
assistants (2nd ed.) St. Louis, MO: Elsevier.
