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G6PDH and malaria prophylaxis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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