Four Generations of Cephalosporins

Hello! This is the outline on four generations of cephalosporins created by Shannon Finucane, Miriah Gilmore, and Natalia Fortygin. Please let us know if we need to correct anything or if we omitted any important information. Your input is greatly appreciated!

Cephalosporins

            -discovered in Sardinia, 1948

            -1960’s Cephalosporins used clinically

            -fungus called Cephalosporium acremonium

           

Cephalosporin Structure and Function

            -Beta-lactum structure

            -inhibits the bacterial enzyme needed for well wall synthesis

            -Bactericidal: bacterial cell lysis and death result

Cephalosporin Generations

            -Four groups (or generations) currently used

            -Each generation is effective against a broader spectrum of bacteria

            -Generations 3 & 4, and some of generation 2 are resistant to beta-lactamase (enzyme that breaks down PCN)

First-Generation Cephalosporins

            -cefadroxil (Duricef)

                        -Availability: PO (1-2 g/d in 1-2 divided doses)

                        -Tx of (or Indication): UTI, beta hemolytic strep, staph skin infections

            -cefazolin sodium (Ancef)

                        -Availability: IV/IM (250mg-2g q6-8h), PO (250-500mg q8h)

                        -Tx of: infections (respiratory, urinary, skin, bone, joint, genitals) and                                                         endocarditis

            -cepalexin (Keflex)

                        -Availability: PO (250-500mg q6h)

                        -Tx of: infections of otitis media, skin, bone, respiratory and urinary tract

            -cephradine (Velosef)

                        -Availability: PO (250-500mg q6h, or 500mg-1g q12h)

                        -Tx of: similar to cephalexin

Second-Generation Cephalosporins

            -cefaclor (Ceclor, Ranoclor)

                        -Availabilty: PO (250-500mg q8h)

                        -Tx of: infections of respiratory, urinary, skin, ear, ampicillin-resistant 
                         strains and certain gram-negative organisms

        

            -cefotetan (Cefotan)

                        -Availability: IM, IV (500mg-2g q12h)

                        -Tx of: gram-negative organisms

            -cefoxitin sodium (Mefoxin)

                        -Availability: IV (1-2g q6-8h)

                        -Tx of: severe infections, septicemia,

            -cefprozil monohydrate (Cefzil)

                        -Availability: PO (250-500 mg daily or q12h)

                        -Tx of: gram-positive bacilli

            -cefuroxime (Ceftin, Zinacef)

                        -Avail: PO (25-500mg q12h), IV/IM ( 750mg-1.5g q8h)

                        -Tx: meningitis, septicemia, cardiothoracic procedures, and surgical prophylaxis

Third-Generation Cephalosporins

            -cefdinir (Omnicef)

                        -Avail: PO (300mg q12h or 600mg daily)

                        -Tx: otitis media, acute sinusitis, chronic bronchitis, pharyngitis/tonsillitis, PNA,                           and skin infections

            -cefixime (Suprax)

                        -Avail: PO (400mg/d in 1-2 divided doses)

                        -Tx: UTI, otitis media, bronchitis, select strep, and gram-negative bacilli

            -cefoperazone (Cefobid)

                        -Avail: IM/IV (1-2g/12h)

                        -Tx: infections of respiratory and urinary tract, female genital tract,

            -cefotaxime (Claforan)

                        -Avail: IM/IV (1-2g q8-12h)

                        -Tx: P. aeruginosa, gram-negative meningitis

            -cefpodoxime (Vantin)

                        -Avail: PO (200mg q12h for10d)

                        -Tx: otitis media, respiratory and urinary tract infections

            -ceftazidime (Fortaz)

                        - Avail: PO (1-2g q8-12h)

                        -Tx: Pseudomanas spp.

            -ceftriaxone (Rocephin)

                        -Avail: IM/IV (1-2g/d)

                        -Tx: Similar to ceftizomine and cefotaxime

            -ceftizoxime sodium (Cefizox)

                        -Avail: PO (500mg-2g q8-12h)

                        -Tx: respiratory, urinary tract, skin, bone, joint infection, and surgical prophylaxis

            -ceftibuten (Cedax)

                        -Avail: PO (400mg/d for 10d)

                        -Tx: chronic bronchitis, pharyngitis, tonsillitis, gram-positive and negative                                      bacteria

            -cefditoren pivoxil (Spectracef)

                        -Avail: PO (200-400mg twice daily for 10d)

                        -Tx: chronic bronchitis, pharyngitis, tonsillitis, skin infections

Fourth-Generation Cephalosporins

            -cefepime (Maxipime)

                        -Avail: IV (0.5-1g q12h, in severe cases 2g q12h for 10d)

                        -Tx: similar to third-generation cephalosporins. Resistant to most beta-lactamase                           bacteria

Side Effects and Adverse Reactions to Cephalosporins

            -GI disturbances (nausea, vomiting, diarrhea)

            -alterations in blood clotting time (increased bleeding)

            -Nephrotoxicity: damage to kidneys with large doses and/or preexisting renal issues

Drug Interactions with Cephalosporins

            -Cephalosporins (Ceffamandole or Cefoperazone) + Alcohol

                        -can cause flushing, HA, N/V, muscular cramps

            -Cephalosporins + Uricosuric drugs

                        -decreased excretion of cephalosporins and resultant increased serum levels

Nursing Consideration

            -Check for allergies to PCN and/or to other cephalosporins

            -Lab work to assess liver and renal function

            -Check C&S prior to administration of any antibiotic

            -Infuse IV cephalosporins over at least 30 minutes to avoid pain or irritation

            -Observe for hypersensitivity reaction

Client Teaching

            -report S/S of Superinfection (mouth ulcers, discharge from anal or genital areas)

            -buttermilk and/or yogurt can help to prevent Superinfection

            -take complete course of ABX

            -take food if GI upset

            -report side effects from PO cephalosporins (anorexia, N/V, HA, dizziness, itching, rash)

Interesting Finding: The most frequent cause of community-acquired, uncomplicated Urinary Tract Infections (UTIs) is enterobacteria, mainly Escherichia coli (E.coli).  According to Garcia-Rodrigues & Bellido (2000), resistance of E. coli to the most commonly used antibiotics, such as, sulfonamides and trimethoprim/sulfamethoxasol, is near 50%. This problem led to the developments of oral cephalosporins. Currently, there are three generations of oral cephalosporins available to treat community acquired, uncomplicated UTIs. The cephalosporins’ pharmokinetics allows for “infrequent dosing intervals and good urinary levels” (Rodrigues & Bellido, 2000, p. 74), thus the bacteria gets destroyed.

References:

García-Rodríiguez, J. A., & Bellido, J. (2000). Oral cephalosporins in uncomplicated urinary tract infections. Clinical Microbiology & Infection, 673.  

Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2012). Pharmacology. A nursing process approach. St. Louis, MO: Elsevier.