Mupirocin Safety in G6PD Deficiency
Yes, mupirocin can be safely given to patients with G6PD deficiency—it is not among the contraindicated medications and poses no documented hemolytic risk.
Evidence-Based Medication Safety Framework
Definitively Contraindicated Medications in G6PD Deficiency
Only seven medications have solid evidence for absolute contraindication in G6PD-deficient patients 1, 2, 3:
- Dapsone 4, 1, 2
- Methylthioninium chloride (methylene blue) 4, 1, 2, 3
- Primaquine 4, 1, 2, 3
- Rasburicase 4, 1, 2, 3
- Nitrofurantoin 3
- Phenazopyridine 3
- Tolonium chloride (toluidine blue) 3
Mupirocin Status
Mupirocin is not listed among contraindicated medications and has no documented association with hemolysis in G6PD-deficient patients 3. The comprehensive evidence-based review examining medications and G6PD deficiency found that many compounds have been wrongly cited as causing hemolysis simply because they were administered during infection-related hemolytic episodes 3.
Clinical Context and Monitoring
When to Screen for G6PD Deficiency
Screening is recommended before starting oxidant drugs in patients of Mediterranean, African, Indian, or Southeast Asian descent 4, 1, 2. However, this screening requirement applies specifically to the seven contraindicated medications listed above, not to topical antibiotics like mupirocin 4, 1.
Real-World Safety Data
A large real-world study of 31,962 G6PD-deficient patients demonstrated that many previously suspected medications were prescribed safely without causing hemolysis 5. Among 71 cases of major hemolysis requiring hospitalization, 71.8% were caused by fava bean ingestion, 8.5% by infections, and only 4.2% were potentially medication-related (involving the known contraindicated drugs) 5.
Practical Recommendations
For topical mupirocin use in G6PD-deficient patients:
- No special precautions or monitoring are required beyond standard clinical practice 3
- The medication can be prescribed with confidence for its indicated uses (skin infections, nasal decolonization) 3
- Patient education should focus on the seven truly contraindicated medications rather than creating unnecessary anxiety about safe medications 1, 3
Important Caveat
If a G6PD-deficient patient develops signs of hemolysis (jaundice, dark urine, fatigue, pallor) while on any medication, consider concurrent infection or other oxidative stressors as the more likely culprit rather than the mupirocin itself 4, 2, 5.