Use of trimethoprim-sulfamethoxazole in a glucose-6-phosphate dehydrogenase-deficient population

Rev Infect Dis. 1987 Mar-Apr:9 Suppl 2:S218-29. doi: 10.1093/clinids/9.supplement_2.s218.


Trimethoprim-sulfamethoxazole (TMP-SMZ) has been associated with hemolytic anemia in patients deficient in glucose-6-phosphate dehydrogenase (G-6-PD). The effect of a daily dose of SMZ of 50 mg/kg was evaluated in a double-blinded study that compared vancomycin with TMP-SMZ given intravenously for treatment of serious Staphylococcus aureus infections. Levels of G-6-PD were determined when patients entered the trial. Most patients were black Americans. G-6-PD-deficient patients were followed serially, with determinations of hemoglobin, haptoglobin, and bilirubin levels, reticulocyte count, and urinalysis. Pretherapy hemoglobin levels were compared with levels during and after therapy. One hundred patients were divided into four groups: group A comprised G-6-PD-deficient patients receiving TMP-SMZ (n = 20); group B, G-6-PD-deficient patients receiving vancomycin (n = 25); and groups C and D, patients with normal G-6-PD levels receiving TMP-SMZ (n = 24) and vancomycin (n = 31), respectively. Groups were comparable in terms of age of patients and duration of therapy. Hemolysis did not occur in any patient receiving TMP-SMZ and occurred in only one patient receiving vancomycin. Both this study and published reports indicate that TMP-SMZ rarely causes hemolysis in a G-6-PD-deficient population.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anemia, Hemolytic / chemically induced*
  • Black People
  • Double-Blind Method
  • Drug Combinations / adverse effects
  • Drug Combinations / therapeutic use
  • Female
  • Glucosephosphate Dehydrogenase Deficiency / complications*
  • Hemoglobins / analysis
  • Humans
  • Male
  • Prospective Studies
  • Random Allocation
  • Staphylococcal Infections / complications
  • Staphylococcal Infections / drug therapy*
  • Sulfamethoxazole / adverse effects
  • Sulfamethoxazole / therapeutic use*
  • Trimethoprim / adverse effects
  • Trimethoprim / therapeutic use*
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • United States
  • Vancomycin / adverse effects
  • Vancomycin / therapeutic use


  • Drug Combinations
  • Hemoglobins
  • Vancomycin
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Trimethoprim
  • Sulfamethoxazole