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Publications

Published: 5 September 2014

Vancomycin and Severe Cutaneous Adverse Reactions (SCARS)

Prescriber Update 35(3): 41
September 2014

Key Messages

  • Vancomycin is associated with a risk of serious skin reactions.
  • Patients should be advised to seek medical advice immediately if signs or symptoms such as a skin rash, conjunctivitis, skin peeling or mouth ulcers occur, as these are associated with the development of serious skin reactions.
  • Vancomycin should be discontinued immediately in the event of a serious skin reaction.


Vancomycin is indicated for potentially life-threatening infections caused by susceptible organisms that cannot be treated with another effective, less toxic antimicrobial drug. The use of vancomycin is limited by its poor oral absorption and potential for nephro- and ototoxicity1, 2.

Vancomycin is associated with a risk of Severe Cutaneous Adverse Reactions (SCARs), which includes Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) and Acute Generalized Exanthematous Pustulosis (AGEP). In addition, literature reports have associated vancomycin with Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) 3.

The Centre for Adverse Reactions Monitoring (CARM) has received seven cases of severe cutaneous adverse reactions associated with vancomycin treatment. In 2014, CARM received a report that described a fatal case of TEN.

Prompt recognition of SCARs and immediate cessation of the causative agent is essential to minimise both morbidity and mortality. Patients should be advised to seek immediate medical attention at the first appearance of a skin rash, conjunctivitis, skin peeling, mouth ulcers, or any sign of hypersensitivity. If serious skin reactions occur, the causative agent such as vancomycin should be discontinued immediately and appropriate treatment commenced.

References
  1. Mylan New Zealand Ltd. 2011. Vancomycin Data Sheet. 25 May 2011. URL: www.medsafe.govt.nz/profs/datasheet/v/VancomycinMylaninf.pdf (accessed 31 July 2014).
  2. Hospira NZ Limited. 2011 DBL. Vancomycin Hydrochloride Data Sheet. 15 December 2011. URL: www.medsafe.govt.nz/profs/datasheet/v/Vancomycininf.pdf (accessed 31 July 2014).
  3. DermNet NZ. 2013. Drug hypersensitivity syndrome. URL: www.dermnetnz.org/reactions/drug-hypersensitivity-syndrome.html (accessed 4 August 2014).
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