From the Research
The correct answer is E. Nitrofurantoin should be avoided in this patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency. This 4-year-old girl presents with symptoms of a urinary tract infection (UTI), including dysuria, lower abdominal pain, and urinary incontinence, with urinalysis confirming infection. Nitrofurantoin is contraindicated in patients with G6PD deficiency because it can trigger hemolytic anemia, as shown in a study published in 2022 1. G6PD is an enzyme that helps protect red blood cells from oxidative damage. When patients with G6PD deficiency are exposed to oxidative stressors like nitrofurantoin, their red blood cells cannot withstand the oxidative stress, leading to hemolysis. The patient's history of hospitalization for hemolytic anemia with confirmed low G6PD levels makes nitrofurantoin particularly dangerous for her. However, a more recent study from 2024 2 suggests that the risk of hemolysis with nitrofurantoin in G6PD-deficient patients may be lower than previously thought, but it still recommends caution. The other antibiotics listed (amoxicillin-clavulanate, cefixime, cefpodoxime, and cephalexin) are all safe options for treating UTIs in patients with G6PD deficiency as they do not cause oxidative stress to red blood cells. Key points to consider in this case include:
- The patient's G6PD deficiency status
- The potential for nitrofurantoin to cause hemolytic anemia in G6PD-deficient patients
- The availability of alternative antibiotics that do not pose this risk
- The importance of weighing the benefits and risks of nitrofurantoin use in this patient population, as discussed in a review published in 2018 3.