Cephalosporins
Prototype: Rocephin (ceftriaxone)
- Cephalosporins are second line to penicillins for group A strep pharyngitis
- Can be cross-sensitive with penicillins
- Can cause C. difficile-associated diarrhea
- Cephalosporins have higher resistance to beta-lactamases
- No Cephalosporin covers Enterococcus (except Ceftaroline)
- Only Ceftazidime & Cefepime cover Pseudomonas
- Only Cefoxitin & Cefotetan have good anaerobic coverage
1st Generation
Cefazolin (Ancef, Kefzol) IV, Cephalexin (Keflex) PO
- Excellent Gram + (MSSA & Strep)
- Minor Gram –
- Used for: non MRSA cellulitus (nonpurulent), Cefazolin used as a prophlaxis during surgery, UTI’s in pregnancy
- Cefazolin in drug of choice for severe MSSA infections in PCN allergic patients
- Covers PEcK (Proteus, E. coli, Klebsiella)
2nd Generation
Cefuroxime (PO & IV)
- Gram + and more Gram- than 1st generation
- Covers: HEN PEcK (H. Influenza, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella)
- Used for: Upper & lower respiratory infections, gonorrhea, UTI’s, Lyme disease (alternative to Doxycycline)
- Cefoxitin & Cefotetan cover anaerobes & Gram – but no Pseudomonas & have week Gram + coverage
- Used for: Community acquired bronchitis
- Bacteroides Fragilis has high rates of resistance to Cefotetan
- Cefotetan can elevate the INR
- Only Cefoxitin & Cefotetan have good anaerobic coverage
3rd Generation
Ceftriaxone (Rocephin) IV, Cefotaxime IV, Cefpodoxime PO
- Good Gram + & excellent Gram – coverage
- This generation is known as the anti-meningeal antiobiotics
- Used for: Rocephin is used in community acquired PNA (with Azithromycin), meningitis, bacterial peritonitis, skin infections UTI’s, pyelonephritis, bone/joint infections, late lyme disease, Gonorrhea, pelvic infections, and more!
- Rocephin is given once daily except for Meningitis (Q 12 hrs) and come is generic form
- Rocephin has a long half life and is not cleared renally
- Rocephin can cause biliary sludging and cholecystitis
- Ceftazidime (Fortaz) only has Gram – coverage, including Pseudomonas
- Ceftazidime & Cefepime are the only Cephalosporins effective against Pseudomonas!
4th Generation
Cefepime IV
- Covers Gram + & Gram -, Pseudomonas. Very week anaerobic coverage
- Used for: Neutropenic fever, hospital acquired PNA, nosocomial meningitis, complicated UTI’s, and more
- Can cause CNS toxicity, confusion and seizures in the elderly and renal patients
5th Generation
Ceftaroline IV
- Covers Gram +, MRSA, VISA, VRSA, VRE, Strep, & Enteroccus Faecalis
- Does not cover Pseudomonas
- Newest Cephalosporin approved by the FDA
| Cephalosporins | General Antimicrobial Spectrum |
|---|---|
| 1st Generation | Gram + (including Staphylococcus aureus) & basic Gram - coverage |
| 2nd Generation | diminished S. aureus, improved Gram - coverage compared to 1st generation. Some have anaerobic coverage |
| 3rd Generation | further diminished S. aureus, improved Gram - coverage compared to 1st & 2nd generation. Some with Pseudomonal coverage & diminished Gram + coverage |
| 4th Generation | same as 3rd generation plus coverage against Pseudomonas |
| 5th Generation | Gram - coverage similar to 3rd generation, also active against S. aureus (including MRSA) & S. pneumoniae |
Key Notes
- When you think of Cephalosporins, think LAME!
- LAME is what Cephalosporins DO NOT COVER: Lysteria, Atypicals, MRSA, Enterococcus (except Ceftarolne)
- Only Ceftaroline covers Enteroccus!
- Ceftazidime & Cefepime are the only Cephalosporins effective against Pseudomonas!
- Cefotetan can elevate the INR
- Only Cefoxitin & Cefotetan have good anaerobic coverage
- The CDC recommends the use of Cephalosporins for the treatment of Gonorrhea
- The drug of choice for Gonorrhea is: Rocephin IM