Cephalosporins

Question 1

What are the first generation Cephalosporins?

Answer 1

**Cefazolin
**Cephalexin (Keflex)
Cefadroxil (Duracef)

Question 2

What are the first generation Cephalosporins effective against?

Answer 2

Gram positive coverage. (Staph and strep)
Skin and soft tissue infection.

Poor efficacy against gram negative
Beta-lactamase producing organisms generally resistant

Question 3

What is the prescription for Cephalexin (Keflex)?

Answer 3

500 mg
One capsule every twelve (12) hours

10 days of therapy

Question 4

What is the prescription for Cefazolin (Ancef™, Kefzol™)?

Answer 4

1 g IVPB
every eight (8) hours

Good for presurgical antibiotic
Renal excretion
Can do IV to PO with Cephalexin

Question 5

What are the Second generation Cephalosporins?

Answer 5

True cephalosporins (No one uses):

• Cefuroxime
• Cefaclor

Cephamycins (USED):

• Cefoxitin
• Cefotetan

Question 6

What are the Second generation Cephalosporins effective against?

Answer 6

Third gen pushed them out, suboptimal for respiratory tract infection; intrabdominal, pelvic inflammatory disease and diabetic foot can use cefotetan. (For deep/anaerobic infections)

Enhanced activity against gram negative bacilli including E. coli, Klebsiella, Serratia and Proteus. Also Anaerobic Bacteroides spp.

Question 7

Prescription for Cefoxitin (Mefoxin™)?

Answer 7

2 g IVPB
every six (6) hours

Question 8

What are the Third generation Cephalosporins?

Answer 8

Cefotaxime (Claforan)

• *Ceftriaxone (Rocephin)
• *Cefdinir (Omnicef)

Question 9

What are the Third generation Cephalosporins effective against?

Answer 9

Enhanced ability to resist beta-lactamases of many gram negative organisms.
Achieve therapeutic levels in cerebrospinal fluid
Resistance and focus of concerns with increased VRE colonization

Drugs of choice for Klebsiella, Enterobacter, Proteus, Providencia, Serratia, and Haemophilus spp, ceftriaxone initial treatment of meningitis; community acquired pneumonia.

For community acquired pneumonia couple it with a macrolide (Erythromycin)

Question 10

Prescription for Ceftriaxone (Rocephin™)?

Answer 10

1 g IVPB
once a day daily

Can do 2g, 2 times a day.
Gonorrhea: 125 mg, IM shot, once.
Meningitis: 4g a day (only one with that large a dose)

Question 11

Prescription for Cefdinir (Omnicef™)?

Answer 11

300 mg
every twelve (12) hours

10 days therapy.
Respiratory: pharyngitis, tonsilitis, maxillary sinusitis, community acquired pneumonia.

Question 12

What are the Fourth generation Cephalosporins?

Answer 12

**Cefepime (Maxipime)

Ceftaroline (Teflaro)

Question 13

What are the Fourth generation Cephalosporins effective against?

Answer 13

Empiric treatment of nosocomial infection where resistance anticipated. (MRSA)

Extended spectrum of activity compared to third generation.
- Useful for empiric treatment of serious infections in hospitalized patients (Neutropenic fever)

Is it a fourth or “fifth”
Ceftaroline (Teflaro™)
Another weapon in the fight against MRSA?
Only used with ID consult!

Question 14

Prescription for Cefepime (Maxipime™)?

Answer 14

2 g IVPB
every twelve (12) hours for 10 days

Infectious disease consult writes this prescription!

Question 15

Possible side effects for Cephalosporins?

Answer 15

Cross allergenicity with pencillins:

• Estimated as high as 20% of penicillin-allergic patients
• Estimated as low as 1% of penicillin-allergic patients

And then there’s:

• Nephrotoxicity
• Diarrhea
• Alcohol intolerance
• Bleeding risk

Question 16

Are there any combos with Cephalosporins?

Answer 16

NO!