What do I advise for the traveller with Glucose 6-phosphate dehydrogenase deficiency?
Glucose 6-phosphate dehydrogenase (G6PD) is an enzyme in the hexose monophosphate shunt of the glycolytic pathway
- this shunt supports the red cell's protection against oxidative damage
- absence of G6PD renders the red cell liable to haemolysis in the presence of some drugs
The most common G6PD deficiency allele in Africa (G6PD A-) has been shown to confer some resistance to malaria in both hemizygous males and heterozygous females
- however, all G6PD-deficient travellers to malarious areas still require appropriate chemoprophylaxis (1)
Chloroquine
- a theoretical risk of haemolysis in some G6PD-deficient individuals who receive chloroquine
- this risk is acceptable in acute malaria (1) and G6PD levels are not usually checked before using chloroquine in treatment doses
- haemolysis does not appear to be a problem when chloroquine is given in the dose recommended for malaria chemoprophylaxis, so there is no need to withhold chloroquine prophylaxis from those known to be G6PD-deficient.
Atovaquone-proguanil, doxycycline, mefloquine or proguanil prophylaxis
- there is no need to withhold any of these agents from those known to be G6PD-deficient.
Primaquine
- this drug is not currently recommended as a first line agent for malaria prevention in UK travellers, but may be considered in special circumstances on expert advice (1)
- there is a definite risk of haemolysis in G6PD-deficient individuals. The traveller's G6PD level must be checked before primaquine is prescribed and G6PD deficiency contraindicates its use for prophylaxis (1)
Reference:
- Public Health England. Guidelines for malaria prevention in travellers from the UK 2019