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.
The cephalosporins are a large beta-lactam group and are among the most widely prescribed antibiotics.
Cephalosporins with the best activity against Pseudomonas:
Cephalosporins lack of activity against LAME:
–Atypicals (including Mycoplasma and Chlamydia)
–MRSA (Except 5th generation)
The only cephalosporins indicated to treat bacterial meningitis are:
Cephalosporins with the best activity against anaerobes:
-The cephamycins, a second-generation subgroup that includes cefoxitin, cefotetan, and cefmetazole.
- 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.
- Cephalosporins MSD Manual (link)
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