In a patient with glucose-6-phosphate dehydrogenase deficiency (G6PD), which class of antibiotics should be avoided?

In patients with glucose-6-phosphate dehydrogenase deficiency (G6PD), sulfonamides should be avoided because they have the potential to trigger hemolytic anemia. G6PD is an important enzyme in the pentose phosphate pathway, which helps protect red blood cells from oxidative stress. When a patient with G6PD deficiency is exposed to certain oxidative agents, including sulfonamides, there can be a significant risk of red blood cell destruction due to the inability of the cells to neutralize oxidants effectively.

Sulfonamides can lead to the production of oxidative metabolites that further exacerbate the oxidative stress on red blood cells, thereby resulting in hemolytic episodes. This is particularly concerning in individuals who already have a compromised ability to handle oxidative stress due to their G6PD deficiency. Therefore, to prevent serious complications, sulfonamides are specifically contraindicated in these patients.

The other classes of antibiotics listed—aminoglycosides, tetracyclines, and penicillins—do not carry the same risk for inducing hemolysis in G6PD-deficient patients, making them safer alternatives in terms of antibiotic choice for these individuals.