glucose - 6 - phosphate dehydrogenase deficiency (G6PD) and malaria prophylaxis

Last edited 12/2019 and last reviewed 09/2022

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