Cephalosporins Flashcards
1st generation cephalosporins have a good spectrum in which bacteria?
- MSSA
- Streptococci
(T/F) - 1st generation cephalosporins are a good alternative to anti-staphylococcal. If so, why?
TRUE - cause less phlebitis and given less frequently
(T/F) - 1st generation cephalosporins cross CNS, so they can be given for CNS infections
FALSE - do not cross CNS and should not be given for CNS infections
1st generation cephalosporins are mainly utilized for?
- MSSA infections (endocarditis)
- Skin and soft tissue infections
- Surgical prophylaxis
- Staph bloodstream infections
What is the most common indication for 1st generation cephalosporins in hospitals?
Surgical prophylaxis
What is important to limit for 1st generation cephalosporins when given for surgical prophylaxis?
Duration of therapy - more than 24 hrs is rarely justified
Do 1st generation cephalosporins lower post-op infections?
It does not
2nd generation cephalosporins have a good spectrum in which bacteria?
- Some enteric GNRs
- Haemophilus influenzae
- Neisseria
Which 2nd generation cephalosporins consist of the N-methylthiotetrazole (MTT) side chain?
- Cefamandole
- Cefotetan
What type of adverse events could happen with cephalosporins containing N-MTT side chains?
- Prolong bleeding by inhibiting the vitamin K production
- Disulfuram-like reactions when alcohol is being consumed
Which 2nd generation cephalosporins can be used for surgical prophylaxis in abdominal surgery?
- Cefoxitin
- Cefotetan
Which 2nd generation cephalosporins do not need to be renally adjusted?
- Cefoxitin
- Cefotetan
2nd generation cephalosporins are mainly utilized for?
- URTI
- CAP
- Gonorrhea
- Surgical prophylaxis (only 2 drugs)
If 2nd generation cephalosporins are used for surgical prophylaxis, what should be done?
Limit duration of therapy after surgery
What should be done if a patient develops an infection while on 2nd generation cephalosporins?
Switch to an alternative agent
3rd generation cephalosporins have a good spectrum in which bacteria?
- Enteric GNRs
- Streptococcus
Which 3rd generation has a good spectrum over pseudomonas?
Ceftazidime
Which 3rd generation cannot be given for streptococcus infections?
Ceftazidime
Which 3rd generation cephalosporins consist of the N-MTT side chain?
Cefpodoxime
Which 3rd generation cephalosporin causes hyperbilirubinemia and biliary sludging in neonates?
Ceftriaxone
Which 3rd generation cephalosporin should be used in neonates instead of ceftriaxone?
Cefotaxime
Ceftazidime lacks activity against which bacteria?
Gram (+)
Ceftriaxone and cefotaxime can be useful in?
Meningitis - excellent CNS penetration
Which 3rd generation does not need to be renally adjusted because it is eliminated by dual modes (renal and biliary)?
Ceftriaxone
3rd generation cephalosporins are mainly utilized for?
- LRTIs
- Pyelonephritis
- Nosocomial infections
- Lyme disease
- Meningitis
- Skin/soft tissue infections
- Febrile neutropenia
- Gonorrhea
Which 3rd gen cephalosporin should be given for nosocomial infections?
Ceftazidime
Which 3rd gen cephalosporin should be given for Lyme disease?
Ceftriaxone
Which 3rd gen cephalosporin should be given for febrile neutropenia and nosocomial infections?
Ceftazidime
(T/F) - Ceftriaxone is a once-daily drug for every indication
FALSE - not for meningitis
Ceftriaxone dose for meningitis is?
2 g IV q 12 h dose
4th generation cephalosporins have a good spectrum in which bacteria?
- Pseudomonas
- Streptococci
- Enteric GNRs
- MSSA
4th generation cephalosporins are a good empiric choice for which indication(s)?
Nosocomial infections
What’s nonbeneficial of giving 4th generation cephalosporins for nosocomial infections? How could it be prevented?
They can overkill community acquired infections. Deescalate if possible
4th generation cephalosporins are mainly utilized for?
- Febrile neutropenia
- Nosocomial infections
What is the primary use for 4th generation cephalosporins?
Nosocomial infections
5th generation cephalosporins have a good spectrum in which bacteria?
- MRSA
- MSSA
- Streptococci
- Enteric GNRs
What are the main utilizations for 5th generation cephalosporins?
- CAP
- Skin/soft tissue infections
(T/F) - Ceftaroline (5th gen) has a greater activity against Gram (-) compared to cefepime (4th gen)
FALSE - 4th gen has greater activity than 5th gen especially in pseudomonas
6th generation cephalosporins have a good spectrum in which bacteria?
- GNRs
- Pseudomonas
- Acinetobacter
- Stenotrophomonas
- Enterobacteriaceae
(T/F) - 6th generation cephalosporins are stable to all classes of the carbapenemase hydrolyzing enzymes
TRUE
6th generation cephalosporins are mainly utilized for?
- Complicated UTIs in adults who have limited or no other Tx options
(T/F) - 6th generation cephalosporins have a gram (-) coverage only, so it’s best to reserve in patients with no other options of MDR GNRs
TRUE
Cephalosporin/beta-lactamase inhibitors have a good spectrum in which bacteria?
- Pseudomonas
- Enteric GNRs
Which cephalosporin/beta-lactamase inhibitor has greater activity for enteric GNRs?
Ceftazidime/avibactam
Which cephalosporin/beta-lactamase inhibitor is active against carbapenem-resistant Klebsiella and other carbapenem-resistant enterobacteriaceae infections?
Ceftazidime/avibactam
(T/F) - Both cephalosporin/beta-lactamase inhibitor are active against pseudomonas
TRUE
What is the main utilization(s) for both cephalosporin/beta-lactamase inhibitor?
- MDR pseudomonas infections
- Mixed aerobic/anaerobic infections
- Intra-abdominal infections
- Infections caused by ESBL-producing organisms
If a cephalosporin/beta-lactamase inhibitor is given for intra-abdominal infections, what should be done?
Add metronidazole due to limited anaerobic activity
