Cefuroxime Safety in G6PD Deficiency Patients
Cefuroxime can be safely administered to patients with G6PD deficiency as it is not among the medications contraindicated in this condition. 1, 2
Understanding G6PD Deficiency and Medication Safety
- G6PD deficiency is the most common enzymatic disorder of red blood cells, affecting approximately 400 million people worldwide 3
- The severity of G6PD deficiency varies based on genetic variant and ethnic background, with the Mediterranean variant (Gdmed) typically causing more severe reactions than the African variant (GdA-) 4, 1
- G6PD-deficient patients lack the ability to protect red blood cells against oxidative stress from certain drugs, metabolic conditions, infections, and fava beans 3
Medications Contraindicated in G6PD Deficiency
- Only seven medications are definitively contraindicated in G6PD deficiency according to evidence-based reviews 5, 2:
- Dapsone
- Methylthioninium chloride (methylene blue)
- Nitrofurantoin
- Phenazopyridine
- Primaquine
- Rasburicase
- Tolonium chloride (toluidine blue)
- These medications can cause severe hemolytic anemia in G6PD-deficient patients 2, 6
Cefuroxime and G6PD Deficiency
- Cefuroxime is not included in any evidence-based lists of medications contraindicated in G6PD deficiency 2, 7
- Comprehensive reviews of medications and G6PD deficiency have not identified cephalosporins, including cefuroxime, as causing hemolytic anemia in these patients 2, 6
- Unlike medications that are known to cause oxidative stress to red blood cells, cefuroxime has not been documented to trigger hemolytic episodes in G6PD-deficient individuals 2
Clinical Considerations
- Screening for G6PD deficiency is recommended before starting therapy with oxidant drugs in patients with predisposing racial or ethnic backgrounds (Mediterranean, African, Indian, or Southeast Asian descent) 4, 1
- When treating G6PD-deficient patients, it's important to monitor for signs of hemolysis, including jaundice, dark urine, fatigue, and pallor, especially when starting any new medication 1
- While cefuroxime is considered safe, it's worth noting that some patients with G6PD deficiency have experienced hemolysis with other antibiotics like amoxicillin, though such cases are rare 8
Practical Recommendations
- Cefuroxime can be administered at standard therapeutic doses to patients with G6PD deficiency 2
- If a patient with G6PD deficiency develops signs of hemolysis while on cefuroxime (which would be unlikely and probably coincidental), the medication should be discontinued and the patient should be monitored closely 3
- For patients with severe G6PD deficiency and multiple comorbidities, consider monitoring hemoglobin levels after initiating treatment, though this is not routinely necessary with cefuroxime 1, 3