Beta - Lactam (Cephalosporins)

Types of beta-lactam antibiotics:

• Penicillins

• Cephalosporins

• Carbapenems

• Aztreonam

What do they inhibit?

• Bacterial cell wall synthesis by binding to penicillin - binding protein

• This prevents the final step of peptidoglycan synthesis in bacterial cell walls

1st Generation

• Cephalexin

• Cefadroxil

• Cefazolin

Cephalexin → Route

• PO

Cefadroxil → Route

• PO

Cefazolin → Route

• IV

2nd Generation

• Cefuroxime

• Cefotetan

• Cefoxitin

• Cefaclor

• Cefprozil

Cefuroxime → Route

• PO

• IV

Cefotetan → Route

• IV

Cefoxitin → Route

• IV

Cefaclor → Route

• PO

Cefprozil → Route

• PO

3rd Generation Group 1

• Cefdinir

• Cefpodoxime

• Cefixime

• Ceftriaxone

• Cefotaxime

Cefdinir → Route

• PO

Cefpodoxime → Route

• PO

Cefixime → Route

• PO

Ceftriaxone → Route

• IV

• IM

Cefotaxime → Route

• IV

• IM

3rd Generation Group 2

• Ceftazidime

Ceftazidime → Route

• IV

4th Generation

• Cefepime

Cefepime → Route

• IV

5th Generation

• Ceftaroline

• Ceftobiprole

Ceftaroline → Route

• IV

Ceftobiprole → Route

• IV

Cephalosporin / Beta - Lactamase Inhibitor

• Ceftazidime / Avibactam

• Ceftolozane / Tazobactam

Ceftazidime / Avibactam → Route

• IV

Ceftolozane / Tazobactam → Route

• IV

Siderophore Cephalosporin

• Cefiderocol

Cefiderocol → Route

• IV

Ceftriaxone Contraindication

• Hyperbilirubinemic neonates

  • Risk of Kernicterus

• Calcium containing IV products in neonates

Ceftriaxone and IV Calcium

• Insoluble precipitates may form when Ceftriaxone is administered in the same line as calcium containing IV fluids

• In adults:

  • These products can be administered at different times of the day if the IV line is flushed with a compatible fluid between administration of each product

• In neonates:

  • Concurrent use (including administration at different times of the day) is contraindicated

Cephalosporin Warnings

• Cross - reactivity with penicillin allergy

Which cephalosporin can cause disulfiram - like reaction with alcohol ingestion?

• Cefotetan

Ceftriaxone Specific Side Effects

• Biliary sludging

Cephalosporin Side Effects

• Seizures

  • With accumulation when not correctly dose adjusted in renal dysfunction cuz cephalosporin are renally cleared

• GI upset

• Diarrhea

• Acute interstitial nephritis

• Myelosuppression with prolonged use

• ↑ LFT

• Rash

  • SJS/TEN, allergic reaction/ anaphylaxis

• Hemolytic anemia

How is Hemolytic anemia identified?

• With a postive Coombs test

Which cephalosporin is available as a chewable tablet?

• Cefixime

Which cephalosporins should be avoided by 2 hours from short acting antacids, and should be completely avoided with H2RA and PPIs?

• Cefuroxime

• Cefpodoxime

• Cefdinir

When is it okay to give a cephalosporin if a patient has a penicillin allergy?

• Mild penicillin allergy

  • Delayed onset reaction (>48 hrs after the first antibiotic dose) appearing as non severe

Which 2nd Generation does NOT cover Anaerobes?

• Cefuroxime

Which cephalosporin covers MRSA?

• Ceftaroline

• Ceftobiprole