Which of the following drug causes hemolytic anemia in glucose–6–phosphate dehydrogenase deficient individual?
**Core Concept:** Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that plays a crucial role in the antioxidant defense of the red blood cells. Glucose-6-phosphate dehydrogenase deficiency is an X-linked genetic disorder that leads to reduced or absent G6PD enzyme activity, making the red blood cells more susceptible to damage from certain drugs and environmental factors. Hemolytic anemia occurs when red blood cells are destroyed faster than they can be replaced, leading to a decrease in hemoglobin and a rise in bilirubin levels.
**Why the Correct Answer is Right:** Amino glycosides, a class of antibiotics, are known to cause hemolytic anemia in glucose-6-phosphate dehydrogenase deficient individuals due to their ability to generate reactive oxygen species that damage the red blood cells. In the absence of G6PD, these reactive oxygen species cause the destruction of red blood cells, leading to hemolytic anemia.
**Why Each Wrong Option is Incorrect:**
A. Paracetamol (acetaminophen): This drug is not associated with hemolytic anemia in G6PD deficient individuals. It is a non-antibiotic medication used for pain relief and fever reduction, with limited pro-oxidant potential.
B. Penicillin: Penicillin is a beta-lactam antibiotic that primarily targets bacterial cell walls, and although it may cause allergic reactions, it does not directly cause hemolytic anemia in G6PD deficient individuals.
C. Isoniazid: Isoniazid is an antitubercular drug that primarily targets Mycobacterium tuberculosis and is generally safe in patients with G6PD deficiency.
D. Sulfamethoxazole: Sulfamethoxazole is a sulfonamide antibiotic that shares a common mechanism with paracetamol, which is not associated with hemolytic anemia in G6PD deficient individuals.
**Clinical Pearl:** Glucose-6-phosphate dehydrogenase deficiency should be considered when evaluating patients with hemolytic anemia, especially in the context of drug exposure. Screening for G6PD deficiency is recommended in patients from areas with a high prevalence of the deficiency before administering potentially harmful medications like those in Options A, B, D, and E. Informing patients about the potential risk and offering alternative medications can prevent severe complications in these individuals.