2. Cephalosporins: Generations, Spectrum, and Clinical Use

Created by E.M.

1st Generation Cephalosporins

Largely effective against gram (+) bacteria with limited ability against gram (-) bacteria, including Proteus mirabilis, E. Coli, and Klebsiella pneumonia.

Proteus mirabilis, E. coli, Klebsiella pneumonia [PEcK]

1st Generation Cephalosporins bacterias PEcK

Cefadroxil, cefazolin, cephalexin.

Examples of 1st Generation

Haemophilus influenzae, Enterobacter aerogenes, Neisseria, PEcK [HENPEcK]

2nd Generation Cephalosporins bacterias HENPEcK

2nd Generation Cephalosporins

Less effective against gram (+) bacteria and enhanced action against gram (-) bacteria, including Haemophilus influenzae, Enterobacter aerogenes, and Neisseria.

Cefaclor, cefamandole, cefonizid, cefotetan, Cefoxitin, Cefmetazole, Cefprozil, Cefuroxime.

Examples of 2nd Generation

3rd Generation Cephalosporins

Less active against gram (+) bacteria; most potent against gram (-) bacteria, including Serratia marcescens.

HEN PECK, Serratia marcescens [HENPEcKS]

3rd Gen bacterias HENPEcKS

Examples of 3rd Generation

Cefnidir, cefixime, cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone.

4th Generation Cephalosporins

Broader spectrum with activity against gram (+) bacteria and more resistant to beta lactamase.

Cefepime, Cefditoren, Ceftaroline.

Examples of 4th Generation

Parenteral.

Mode of Administration of Cephalosporins

• liver; urine

• GI tract

Pharmacokinetics of Cephalosporins

• Primarily metabolized in the ____ and excreted in the ____;

• crosses the placenta and enters breast milk;

• well absorbed from the ___ ___.

Nephrotoxicity

What do combination of cephalosporins and aminoglycosides increases the risk of?

• Blood Urea Nitrogen (BUN)

• creatinine

Nephrotoxicity Tests

Oral Anticoagulants

___ ___ may experience increased bleeding; monitor for blood loss with cephalosporins

Disulfiram like Reaction

What is the reaction between cephalosporins and alcohol, which is why alcohol consumption should be avoided for a certain number of days?

Uricosuric Drugs (Probenecid)

What decreases excretion of cefaclor, a cephalosporin?

72 hours

How long should alcohol consumption be avoided after consuming a cephalosporin?

• Bactericidal and bacteriostatic

• Attach to penicillin binding proteins to inhibit bacterial cell and wall synthesis

What is the action of cephalosporins?

2. Otitis Media

The following are indications for cephalosporins:

1. Respiratory infections

2. __ ___

3. Bone/joint infections

4. Genitourinary tract

5. Peripoperative period

penicllin

Contraindications of cephalosporins

• History of allergy to ___

• Cautious for patients with renal failure and bleeding disorder/hepatic failure

• Nausea

• Vomiting

• Diarrhea

• Anorexia

• Abdominal Pain

• Flatulence

• Pseudomembranous colitis

• Aplastic anemia

• Toxic epidermal necrolysis

Adverse GI effects of cephalosporins

with food

Most cephalosporins may be given ___ ___ to prevent GI upset

Ceftibuten (Cedax)

What cephalosporin should not be given food?

Cefdinir

What cephalosporine is given without regard to food?

1. Cerfuroxime

2. Cefpodoxime

What are the cephalosporins that have better absorption if with food?

refrigerated

Suspensios of cephalosporin should be ___

Antibiotic Associated Pseudomembranous Colitis (AAPMC)

Diarrhea that may be an adverse effect of cephalosporins

1. Small frequent feedings

2. Mouth care

3. Ice chips.

Stomatitis Management