Cell Wall Inhibitors- Cephalosporins

Question 1

1° Forms:

Answer 1

PO: cephalexin (Keflex®) IV: cefazolin (Ancef®)

Question 2

1° Coverage

Answer 2

GP: Good with the exception of Enterococcus and MRSA GN: E. coli, Klebsiella, Proteus, H. influenzae (not all isolates)

Question 3

1° MOA

Answer 3

Bactericidal: β-lactam inhibits PBP, prevents cross- linking of peptidoglycan, less susceptible to penicillinases

Question 4

1° Adverse Effects

Answer 4

10% penicillin allergy cross-reactivity

Question 5

1° Indications

Answer 5

Skin and soft tissue infections prevention of surgical site infections (cefazolin) infections caused by susceptible organisms (especially Staph and Strep infections)

Question 6

1° Contraindications

Answer 6

Hypersensitivity to cephalosporins or other β-lactam antibiotics

Question 7

2° Forms:

Answer 7

PO: cefuroxime (Ceftin®), cefprozil (Cefzil®) IV: cefuroxime (Zinacef®) cefoxitin NOTE: Same MOA, Adverse Effects and Contraindications as 1°

Question 8

2° Coverage GP

Answer 8

Weaker activity than 1°

Question 9

2° Coverage GN

Answer 9

More coverage than 1° (Aincludes anaerobes)

Question 10

2° Indications

Answer 10

Upper and lower respiratory tract infections; pneumococcal pneumonia; soft tissue infections

Question 11

3° Forms:

Answer 11

PO: cefixime (Suprax®) IV: ceftriaxone (Rocephin®) cefotaxime (Claforan®) ceftazidime (Fortaz®) NOTE: Same MOA as 1°

Question 12

3° Coverage GP

Answer 12

S. aureus + streptococcal coverage (cefotaxime and ceftriaxone) especially S. pneumoniae

Question 13

3° Coverage GN

Answer 13

Broad coverage (includes Pseudomonas for ceftazidime only)

Question 14

3° Adverse Effects

Answer 14

~1% penicillin allergy cross- reactivity

Question 15

3° Indications

Answer 15

Community-acquired pneumonia (cefotaxime, ceftriaxone) gonorrhea (use ceftriaxone) community-acquired bacterial meningitis (ceftriaxone, cefotaxime) abdominal and pelvic infections (cefotaxime or ceftriaxone in combination with metronidazole) once-daily administration makes ceftriaxone convenient for outpatient IV therapy

Question 16

3° Contraidications

Answer 16

Severe hypersensitivity (Type I) to other β-lactam antibiotics

Question 17

4° Form:

Answer 17

cefepime (Maxipine®) IV NOTE: Same MOA as first gen and same Adverse Effects and Contraindications as 3rd gn

Question 18

4° coverage for GP and GN

Answer 18

Broad coverage including Pseudomonas

Question 19

4° Indications

Answer 19

Empiric therapy for febrile neutropenia