The term “red man syndrome” has been widely used historically to describe the infusion reaction associated with vancomycin. The authors argue that this phrase is racist in origin and usage and should never be used to describe the clinical event. They recommend adopting neutral, descriptive terminology—most consistently vancomycin infusion reaction—in all clinical, educational, administrative, and electronic contexts in Canada.
Vancomycin infusion reaction is an idiopathic, non–immunoglobulin E–mediated anaphylactoid reaction caused by endogenous histamine release from mast cells. First described in 1959, manifestations include flushing, erythema, warmth (especially of the upper torso, neck, and face), pruritus, myalgias, dyspnea, and hypotension. Using descriptive terminology such as vancomycin infusion reaction or vancomycin flushing reaction/syndrome helps recognition of the clinical spectrum across diverse populations.
The words “red man” extend beyond a literal visual description and are rooted in a longstanding racial slur directed at Indigenous Peoples in North America. The phrase has appeared in popular culture and institutional names for centuries. The authors note that continued use in medicine perpetuates racism and undermines efforts toward culturally safe care and reconciliation.
Although several US medical societies—including infectious diseases, pediatric infectious diseases, epidemiology, infectious diseases pharmacy, and HIV medicine groups—issued a joint statement in 2021 recommending abandonment of the offensive term, the expression remains in use in Canada. The authors cite examples identified via internet searches showing the term used by hospitals, a provincial home-care agency, and national medication-safety organizations. They state they are not aware of an equivalent coordinated call from Canadian organizations and therefore issue this recommendation for Canada.
The authors recommend replacing the offensive phrase with vancomycin infusion reaction in all verbal and written communications. Alternatives suggested include vancomycin flushing reaction or vancomycin flushing syndrome, consistent with earlier descriptions. They advise modifying teaching materials, clinical decision support tools, guidelines and position statements, clinical pharmacy databases, adverse-event reporting databases, and product monographs to reflect the preferred terminology.
Education for learners and health professionals at all levels is emphasized as a key mechanism to change practice. The authors cite a US study showing that 62% of vancomycin-related “allergic” events identified by an antimicrobial stewardship team used the offensive term. After educational interventions and enabling automatic substitution of terminology in electronic medical records, use of the term declined by about 20% within five months. The authors recommend similar approaches—education plus technical measures such as auto-substitution—in Canadian settings to drive rapid change.
Professional societies, regulatory bodies, hospitals, and academic programs all share responsibility to stop using discriminatory language. The authors list several Canadian organizations that should act, including specialty societies, pharmacy associations, and curriculum developers. They recommend auditing teaching materials (slides, notes, tutorials) and requiring learners to demonstrate culturally safe care for Indigenous patients. Federal regulators responsible for pharmaceutical approvals should require updates to product monographs where wording is outdated.
Eliminating the term “red man syndrome” is framed as an important and immediate step toward addressing systemic, interpersonal, and institutional racism in Canada’s health care systems. The authors urge all clinical, educational, and administrative bodies to make members aware of appropriate terminology, update documents and electronic systems, and use the vancomycin infusion reaction label consistently to promote respectful, culturally safe care and advance reconciliation.
Acknowledgements and disclosures from the original article noted that authors wrote on behalf of several Canadian professional groups and reported specified competing interests. The article has been peer reviewed and is Open Access under a Creative Commons licence. Specific references and cited documents were provided in the source article for readers seeking original sources and examples.