Cephalosporins

10%

What is the rate of cross-sensitivity between cephalosporins and penicillins?

Inhibit bacterial cell wall synthesis by binding to PBPs, which blocks the transpeptidation (cross-linking) step of peptidoglycan synthesis, leading to a weakened cell wall and ultimately cell lysis (bactericidal effect)

MOA of Cephalosporins

GI upset, diarrhea

C. diff

Hypersensitivity reactions, rash

Acute interstitial nephritis

Increased LFTs

Myelosuppression

Drug fever

Seizures

SEs of Cephalosporins

Hypersensitivity reactions

Renal function

LFTs

CBC

Monitoring parameters for Cephalosporins

Warfarin

H2RAs

PPIs

DDIs with Cephalosporins

Enterococcus

- Ceftaroline (5th gen) does have some activity against E. facaelis

No cephalosporin is active against _____.

Cefazolin (Ancef) [IV, IM]

Cephalexin (Keflex) [PO]

Cefadroxil (Duricef) [PO]

Cephalothin

List the first-generation Cephalosporins

staph

First-generation Cephalosporins are stable in the presence of β-lactamase produced by ____ but unstable in the presence of other β-lactamases

MSSA

Streptococcus

Klebsiella

E. coli

Proteus Mirabilis

Spectrum of activity for first-generation Cephalosporins

- Cefazolin (Ancef) [IV, IM]

- Cephalexin (Keflex) [PO]

- Cefadroxil (Duricef) [PO]

- Cephalothin

surgical prophylaxis

SSTIs

MSSA

Strep throat

Clinical uses for first-generation Cephalosporins

- Cefazolin (Ancef) [IV, IM]

- Cephalexin (Keflex) [PO]

- Cefadroxil (Duricef) [PO]

- Cephalothin

Cefuroxime (Ceftin) [IV, PO]

Cefoxitin (Mefoxin) [IV]

Cefotetan (Cefotan) [IV]

Cefprozil (Cefzil)[PO]

Cefaclor (Ceclor) [PO]

List the second-generation Cephalosporins

MSSA

Streptococcus

Haemophilus

Klebsiella

E. coli

Proteus mirabilis

Neisseria

Anaerobes (Cefoxitin and Cefotetan only)

Spectrum of activity for the second-generation Cephaloporins

- Cefuroxime (Ceftin) [IV, PO]

- Cefoxitin (Mefoxin) [IV]

- Cefotetan (Cefotan) [IV]

- Cefprozil (Cefzil)[PO]

- Cefaclor (Ceclor) [PO]

Cefoxitin (Mefoxin) and Cefotetan (Cefotan)

What are the only two second-generation Cephalosporins with anaerobic coverage?

URTIs

CAP

Gonorrhea

Surgical prophylaxis: Cefoxitin, Cefotetan, Cefuroxime

Clinical uses for the second-generation Cephaloporins

- Cefuroxime (Ceftin) [IV, PO]

- Cefoxitin (Mefoxin) [IV]

- Cefotetan (Cefotan) [IV]

- Cefprozil (Cefzil)[PO]

- Cefaclor (Ceclor) [PO]

Cefoxitin (Mefoxin)

Cefotetan (Cefotan)

Cefuroxime (Ceftin)

List the second-generation Cephalosporins used for surgical prophylaxis.

Ceftriaxone (Rocephin) [IV, IM]

Cefotaxime (Claforan) [IV, IM]

Ceftazidime (Fortaz) [IV, IM]

Cefdinir (Omnicef) [PO]

Cefpodoxime (Vantin) [PO]

Cefixime (Suprax) [PO]

Ceftibuten (Cedax) [PO]

Cefditoren (Spectracef) [PO]

List the third-generation Cephalosporins

MSSA (except Ceftazidime)

Streptococcus (except Ceftazidime)

Pseudomonas (Ceftazidime only)

Klebsiella

E. coli

Haemophilus

Proteus

Neisseria

Spectrum of activity for the third-generation Cephalosporins

- Ceftriaxone (Rocephin) [IV, IM]

- Cefotaxime (Claforan) [IV, IM]

- Ceftazidime (Fortaz) [IV, IM]

- Cefdinir (Omnicef) [PO]

- Cefpodoxime (Vantin) [PO]

- Cefixime (Suprax) [PO]

- Ceftibuten (Cedax) [PO]

- Cefditoren (Spectracef) [PO]

LRTIs

CAP

Gonorrhea

Lyme disease (Ceftriaxone)

Meningitis

Pyelonephritis

Bacterial peritonitis

SSTIs

Febrile neutropenia (Ceftazidime)

Clinical uses of the third-generation Cephalosporins

- Ceftriaxone (Rocephin) [IV, IM]

- Cefotaxime (Claforan) [IV, IM]

- Ceftazidime (Fortaz) [IV, IM]

- Cefdinir (Omnicef) [PO]

- Cefpodoxime (Vantin) [PO]

- Cefixime (Suprax) [PO]

- Ceftibuten (Cedax) [PO]

- Cefditoren (Spectracef) [PO]

Cefepime (Maxipime) [IV, IM]

List the fourth-generation Cephalosporin

MSSA

Streptococcus

Enteric GNRs

Pseudomonas

Acinetobacter

Amp C (SPACE) and ESBL-producing organisms (E. coli, Klebsiella)

Spectrum of the fourth-generation Cephalosporin, Cefepime (Maxipime)

Nosocomial infections

Febrile neutropenia

Clinical use of the fourth-generation Cephalosporin, Cefepime (Maxipime)

Ceftaroline (Teflaro)

List the fifth-generation Cephalosporin

MSSA

MRSA

Streptococcus

Enteric GNRs

Enterococcus faecalis

Spectrum of activity for the fifth-generation Cephalosporin, Ceftaroline (Teflaro)

SSTIs

CAP

MRSA infections

Clinical uses for the fifth-generation Cephalosporin, Ceftaroline (Teflaro)

Avycaz: Ceftazidime (3rd) / Avibactam

Zerbaxa: Ceftolozane / Tazobactam

List the Cephalosporin/Beta-Lactamase Inhibitor Combos

Enterobacter cloacae

E. coli

Haemophilus

Klebsiella pneumoniae, oxytoca

Citrobacter

Proteus mirabilis

MDR Pseudomonas

ESBL-producing organisms

CRE (Avycaz only)

List the spectrum of activity for the Cephalosporin/Beta-Lactamase Inhibitor Combos

- Avycaz: Ceftazidime (3rd) / Avibactam

- Zerbaxa: Ceftolozane / Tazobactam

Intra-abdominal infections

UTIs

HABP

VABP

Clinical uses for the Cephalosporin/Beta-Lactamase Inhibitor Combos

- Avycaz: Ceftazidime (3rd) / Avibactam

- Zerbaxa: Ceftolozane / Tazobactam

Cefiderocol (Fetroja) [IV]

List the siderophore cephalosporin

Inhibition of cell wall synthesis and binds to extracellular free ferric iron using a siderophore iron uptake mechanism

MOA for the Siderophore Cephalosporin, Cefiderocol (Fetroja)

Infusion site reactions

Rash

Increased LFTs

Diarrhea, constipation, n/v

Candidiasis

Cough

Hypokalemia

Headache

SEs of Cefiderocol (Fetroja)

Cefiderocol

Which Cephalosporin can cause false-positive results for dipstick tests (urine protein, ketones, occult blood)?

E. coli

Klebsiella pneumoniae

Proteus mirabilis

Pseudomonas aeruginosa

Enterobacter cloacae complex

Spectrum of activity for Cefiderocol (Fetroja)

cUTI, including pyelonephritis

Clinical uses of Cefiderocol (Fetroja)