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The antibiotic vancomycin is used to treat Staphylococcus infections that are resistant to penicillin or other antibiotics. The most common side effect of vancomycin is the red man syndrome, which is characterized by the development of a local skin rash and/or hypotension (low blood pressure). The disorder usually resolves after discontinuing the drug. The prevalence of red man syndrome and factors that may predispose to this disorder were assessed. Of 650 children treated with vancomycin, 11 developed the red man syndrome. They were compared with 11 other vancomycin-treated children who did not develop the syndrome. Vancomycin was given for penicillin-resistant Staphylococcus infection or because of penicillin allergy in 73 percent of the children with an adverse reaction and 45 percent of those without a reaction. The average duration of the vancomycin infusion was 46 minutes in patients with the syndrome and 54 minutes in children without it. Slower infusion rates reduced or prevented the syndrome in five patients, indicating the relation of administration of this drug to the development of the side effect. The onset of red man syndrome usually occurred at the end of the infusion, but was also noted as early as 15 minutes after the start of the infusion. The disorder was characterized by a reddish rash on the face, neck, and ears, intense itching, symptoms of hypotension, watery and puffy eyes, a rapid heart rate, respiratory distress, dizziness, agitation, and a mild increase in body temperature. The rash usually disappeared within 20 minutes of stopping the vancomycin infusion. The development of the rash was not related to the blood levels of vancomycin, indicating that the red man syndrome is an idiosyncratic or unusual reaction, rather than a phenomenon that is dependent on the blood concentration of the drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective. An outbreak of severe acute respiratory syndrome (SARS) occurred in the greater Toronto area between February and June 2003. We describe the clinical, laboratory, and epidemiologic features of children who were admitted to the Hospital for Sick Children, Toronto, with a presumptive diagnosis of suspect or probable SARS. Methods. A prospective investigational study protocol was established for the management of children with a presumptive diagnosis of suspect or probable SARS. All were ultimately classified as having probable SARS, suspect SARS, or another cause on the basis of their epidemiologic exposure, clinical and radiologic features, and results of microbiologic investigations. Results. Twenty-five children were included; 10 were classified as probable SARS and 5 were classified as suspect SARS, and in 10 another cause was identified. The exposure consisted of direct contact with at least 1 adult probable SARS case in 11 children, travel from a World Health Organization-designated affected area in Asia in 9 children, and presence in a Toronto area hospital in which secondary SARS spread had occurred in 5 children. The predominant clinical manifestations of probable cases were fever, cough, and rhinorrhea. With the exception of 1 teenager, none of the children developed respiratory distress or an oxygen requirement, and all made full recoveries. Mild focal alveolar infiltrates were the predominant chest radiograph abnormality. Lymphopenia; neutropenia; thrombocytopenia; and elevated alanine aminotransferase, aspartate aminotransferase, and creatine kinase were present in some cases. Nasopharyngeal swab specimens were negative for the SARS-associated coronavirus by an in-house reverse transcriptase-polymerase chain reaction in all 25 children. Conclusions. Our results indicate that SARS is a relatively mild and nonspecific respiratory illness in previously healthy young children. The presence of fever in conjunction with a SARS exposure history should prompt one to consider SARS as a possible diagnosis in children irrespective of the presence or absence of respiratory symptoms. Reverse-transcriptase polymerase chain reaction analysis of nasopharyngeal specimens seems to be of little utility for the diagnosis of SARS during the early symptomatic phase of this illness in young children. Pediatrics 2003;112:e261-e268. URL: http: //www.pediatrics.org/cgi/content/full/112/4/e261; severe acute respiratory syndrome, reverse-transcriptase polymerase chain reaction, probable SARS, suspect SARS.