2017 / 6 December

Cephalosporins


Cephalosporins are β-lactam antibiotics (penicillin-family) with bactericidal effect. They disrupt cell synthesis by inhibiting enzymes in the cell wall of bacteria. There are five generations of cephalosporins. First-generation cephalosporins are most active against gram-positive bacteria, particularly Staphylococcus aureus. Second-generation cephalosporins are often used for polymicrobial infections that include gram-negative bacilli and gram-positive cocci. Third-generation cephalosporins have excellent activity against gram-negative bacteria, for example, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis.The fourth-generation cephalosporins have enhanced stability against B-lactamase enzymes (ampC β-lactamase or extended-spectrum β-lactamase). Ceftaroline is a fifth-generation cephalosporin. It’s active against Methicillin-resistant S. aureus (MRSA) and E. faecalis.

Drugs

1st generation
-Cefazolin
-Cephalexin

2nd generation
-Cefoxitin
-Cefaclor
-Cefuroxime

3rd generation
-Ceftriaxone
-Cefotaxime
-Ceftazidime
-Cefixime

4th generation
-Cefepime

5th generation
-Ceftaroline

The cephalosporins are a large beta-lactam group and are among the most widely prescribed antibiotics.

Cephalosporins with the best activity against Pseudomonas:

-Ceftazidime

-Cefoperazone

Cephalosporins lack of activity against LAME: 

Listeria

Atypicals (including Mycoplasma and Chlamydia)

MRSA (Except 5th generation)

Enterococci

The only cephalosporins indicated to treat bacterial meningitis are:

-Ceftriaxone

-Cefotaxime

-Ceftazidime

-Cefepime

Cephalosporins with the best activity against anaerobes:

-The cephamycins, a second-generation subgroup that includes cefoxitin, cefotetan, and cefmetazole.

References

  • Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267.
  • McGill F, Heyderman RS, Panagiotou S, et al. Acute bacterial meningitis in adults. Lancet 2016; 388:3036.
  • Marshall WF, Blair JE. The cephalosporins. Mayo Clin Proc. 1999 Feb;74(2):187-95.

Further reading:

  • Cephalosporins MSD Manual (link)

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