Cefuroxime Can Be Safely Given to G6PD-Deficient Patients
Cefuroxime is safe to use in patients with G6PD deficiency, as cephalosporins are not among the medications known to cause hemolysis in these patients.
Evidence-Based Medication Safety in G6PD Deficiency
The most comprehensive evidence reviews have identified only seven medications with solid evidence for causing hemolysis in G6PD-deficient patients: dapsone, methylthioninium chloride (methylene blue), nitrofurantoin, phenazopyridine, primaquine, rasburicase, and tolonium chloride 1. Cefuroxime and other cephalosporins are notably absent from this list of contraindicated medications 2, 3, 1.
Why Cefuroxime Is Safe
- Cephalosporins, including cefuroxime, have not been documented to cause oxidative stress sufficient to trigger hemolysis in G6PD-deficient patients 1
- A large real-world study of 31,962 G6PD-deficient patients found that the vast majority of hemolytic episodes (71.8%) were caused by fava bean ingestion, with only 3 cases (4.2%) potentially medication-related—none involving cephalosporins 4
- The guideline literature specifically addressing cefuroxime safety confirms no contraindication exists for its use in G6PD deficiency 3
Clinical Context and Monitoring
While cefuroxime itself is safe, consider these practical points:
- For patients with severe G6PD deficiency and multiple comorbidities, monitoring hemoglobin levels after initiating treatment may be prudent, though this is not routinely necessary 3
- The underlying infection being treated (not the antibiotic) can itself trigger hemolysis in G6PD-deficient patients, as infections accounted for 8.5% of hemolytic episodes in one large cohort 4
- Watch for clinical signs of hemolysis including jaundice, dark urine, fatigue, and pallor when starting any new medication in the context of acute illness 3
Common Pitfall to Avoid
Many medications have been wrongly labeled as dangerous in G6PD deficiency because they were administered during infection-related hemolytic episodes 1. This historical confusion has led to unnecessarily restrictive medication lists. The evidence clearly shows that cefuroxime and other beta-lactam antibiotics do not cause hemolysis in G6PD-deficient patients when used at normal therapeutic doses 1.