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.

           

Tetracyclines

Hi,
This post is for Bonnie Lee and Jisun Kang. Please let us know if we have missed anything, your feedback is greatly appreciated.

Thank you,
 Bonnie & Jisun

Tetracylcines:

·         Isolated from Streptomyces in 1948.

·         First broad-spectrum antibiotic effect against gram positive and gram-negative bacteria and other organisms.

Action

·         This medication is used to treat bacterial infections through inhibiting the bacterial protein synthesis and have a bacteriostatic effect

Indications 

·         Short-Acting Tetracycline

tetracycline (Sumycin)

-          is used for infections caused by  Gram-positive and gram-negatice microorganisms for Pneumonia and other respiratory tract infections, Skin disorders, Chlamydia, Gonorrhea, syphilis, Rickettsia Infections

 

·         Intermediate-Acting Tetracycline  

                demaclocycline HCl (Declomycin)

-          is used for gram-positve and gram-negative bacteria 

·         Long-Acting Tetracycline   

doxycycline hycalate (Vibramycin)

minocycline HCl (Minocin)

-          is used for bacterial infections and acne 

• Glyclycclines

 Tigecycline (Tygacil)

-          Used for complicated skin and intrabdominal infections

 

Interactions

•        My increase effect of warfarin

•        May decrease effects of oral contraceptives

•        Antacids

•        Sucralfate may prevent absorption

•        Antiadiarrheal medications

•        Barbituates

•        Calcium in foods or dairy products

 

Route 

·         Oral – most frequent and newer oral preparation, such as doxycycline and minocycline are rapidly and completed absorbed. It is recommended that Tetracylcine be taken on an empty stomach except for doxycycline and minocycline. 

·         IM – causes pain on injection and tissue irritation and is seldom used 

·         IV – to treat severe infections

 

Contraindications

•        Hypersensitivity,

•        Severe hepatic disease or renal disease

•        Pediatrics: Children under the age of 8 should not be prescribed Tetracyclines due to the permanent/irreversible discoloring of teeth.

•        Pregnancy: Should not be taken in 1^st trimester of pregnancy due to teratogenic affects

•        Lac: Lactation

 

Side/Adverse Effects

·         GI disturbances: nausea, vomiting, and diarrhea, esophagitis

·         Dizziness

·         Photosensitivity may occur  (especially Declomycin)

·         Rashes

·         Hepatoxicity

·         Pancreatitis

·         Blood Dyscrasias

·         Hypersensitivty

·         Superinfections due to the disruption of intestinal flora 

 Nursing implications

·         Obtain a patient’s history: allergy to tetracycline, liver or renal dysfunction, pregnancy, lactation, dietary intake and drugs client currently takes.

·         Check renal and liver function. (BUN, Serum creatinine, AST, ALT, Bilirubin)

·         Assess and record vital sign and urine output.

·         Check culture and sensitivity before starting antibiotic therapy

·         Administer oral medication on an empty stomach, 1 hour before or 2 hours after meals.

·         Do not give with antacids. (If antacids must be used, give them 3 hours after the dose of tetracycline.)

·         Do not administer during pregnancy. (teratogenic effect)

·         Do not use outdated drugs. (nephrotoxic effect)

·         Monitor laboratory values regularly for liver and kidney functions. (Liver enzymes, BUN, Serum creatinine) 

Patient teaching

·         Educate patients to take tetracycline on an empty stomach, 1 hour before or 2 hours after meals, with a full glass of water.

·         Instruct patients not to take the drug with milk products, iron, and antacids.

·         Advise patients to check expiration date on the bottle of tetracycline.

·         Instruct patients to store tetracycline away from light and extreme heat.

·         Encourage patients to use sun block and protective clothing during sun exposure. (photosensitivity)

·         Advise patients to use additional contraceptive techniques to avoid pregnancy. (The desired action of oral contraceptives can be lessened when taken with tetracycline.)

·         Warn parents that children less than 8 years old should not take tetracycline. (discoloration of permanent teeth)

·         Teach patients to use effective oral hygiene several times a day. (stomatitis)

·         Instruct patients to report signs of a superinfection. (mouth ulcers, anal or genital discharge)

·         Advise patients to take the full course of tetracycline.

 References

Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2012). Pharmacology. A nursing process approach.

                 St. Louis, MO: Elsevier.

http://web.squ.edu.om/med-lib/med_cd/e_cds/Nursing%20Drug%20Guide/mg/tetracycline_hydrochloride.htm

Vallerand, A. ,  Sanoski, C. A. & Deglin, J., & (2013). Davis's drug guide for nurses. (13^th ed).

             Philadelphia: F.A. Davis Company.