From the Guidelines
Patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency should avoid several antibiotics due to the risk of triggering hemolytic anemia, primarily sulfonamides, nitrofurantoin, and dapsone, as these can cause oxidative stress in red blood cells. The primary antibiotics contraindicated in G6PD deficiency include:
- Sulfonamides (such as sulfamethoxazole, often found in combination as trimethoprim-sulfamethoxazole/Bactrim)
- Nitrofurantoin
- Dapsone These medications can cause oxidative stress in red blood cells, which normally would be countered by the G6PD enzyme. Since G6PD-deficient patients lack sufficient enzyme activity to protect their red blood cells from oxidative damage, these antibiotics can lead to rapid destruction of red blood cells, resulting in hemolysis. The severity of hemolytic reactions varies based on the specific G6PD variant the patient has and the degree of enzyme deficiency. Some quinolones like ciprofloxacin have also been reported to cause hemolysis in some cases, though this occurs less frequently. When treating infections in G6PD-deficient patients, alternative antibiotics such as penicillins, cephalosporins, macrolides, and tetracyclines are generally considered safer options. If a contraindicated antibiotic must be used due to lack of alternatives, close monitoring of the patient's hemoglobin levels and signs of hemolysis is essential, as noted in studies such as 1.
From the FDA Drug Label
CONTRAINDICATIONS Severe glucose-6-phosphate dehydrogenase (G6PD) deficiency PRECAUTIONS General Hemolysis and Heinz body formation may be exaggerated in individuals with a glucose-6-phosphate dehydrogenase (G6PD) deficiency
The following antibiotics are contraindicated or should be used with caution in patients with G6PD deficiency:
- Primaquine is contraindicated in patients with severe G6PD deficiency 2, 2
- Dapsone should be given with caution to patients with G6PD deficiency, as hemolysis and Heinz body formation may be exaggerated 3 Key points to consider:
- G6PD testing should be performed before using primaquine 2
- Baseline hematocrit and hemoglobin must be checked before treatment with primaquine, and close hematological monitoring is required 2
- Adequate medical support should be available to manage hemolytic risk in patients with G6PD deficiency 2
From the Research
Contraindicated Antibiotics for G6PD Deficiency
The following antibiotics are contraindicated in patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency:
Other Medications
Other medications that may be contraindicated in G6PD-deficient patients include:
Safe Medications
Some medications that were previously thought to be contraindicated in G6PD-deficient patients have been shown to be safe in normal therapeutic doses, including: