Cephalosporins Flashcards
What are the general characteristics of cephalosporins?
- More resistant to Beta lactamase than PCNs
- Lack activity against MRSA and enterococcus: except ceftaroline 5th gen
- Cause hypersensitivty rxns like PCN: cross reactivity likely 1%
- Lack activity against B. fragilis
What are the first generation cephalosporins?
- Cefazolin
2. Cephalexin (keflex)
What is the route for Cefazolin and cephalexin?
- Cefazolin: IV
2. Cephalexin (keflex): PO
What is the gram positive spectrum of activity for Cefazolin and cephalexin?
- MSSA
2. Streptococci
What enteric gram negative rods are Cefazolin and cephalexin effective against?
- Enterobacteriaceae: unpredictable
- Klebsiella pnuemoniae
- E. coli
- Proteus Mirabilis
What anaerobes are Cefazolin and cephalexin not effective against?
B. fragilis
What are the clinical uses for Cefazolin and cephalexin?
- Cefazolin:
A. Surgical prophylaxis, 24 hrs prior, Add metronidazole (flagyl) for colon surgery
B. MSSA bacteremia and endocarditis - Skin and soft tissue infection
What are the SE for Cefazolin and cephalexin?
Allergic rxn
What are the second generation cephalosporins?
- True cephalosporins: good ability to cross BBB
A. Cefuroxime (ceftin) - Cephamycins
A. cefoxitin (mefoxin)
What is the route of administration for Cefuroxime (ceftin) and cefoxitin (mefoxin)?
- Cefuroxime (ceftin): IV, PO
2. cefoxitin (mefoxin): IV
What gram positive bacteria are Cefuroxime (ceftin) and cefoxitin (mefoxin) effective against?
- Strep pneumonieae
A. Cefoxitin less active
What gram negative bacteria is Cefuroxime (ceftin) effective against?
- H. influenza
- N. gonorhea
- M. Catarrhalis
- some enterobacteria
What gram negative bacteria is cefoxitin (mefoxin) effective against?
- E. coli
- Klebsiella
- Less active against H. influenza
What anaerobes is cefoxitin (mefoxin) effective against?
- B. fragilis
What are the clinical uses for Cefuroxime (Ceftin)?
- Community acquired resp tract infections
What are the clinical uses for Cefoxitin (Mefoxin)?
- Intra-abominal infections, pelvic/Gyn infections
- Mixed aerobe/anaerobe soft tissue infections
- Surgical propylaxis in colon surgery
What are the SE for second generation cephalosporins?
Allergic rxns
What are the third generation cephalosporins?
- Ceftazadime (fortaz)
- cefpodoxime (vantin)
- ceftriaxone (rocephin)
What is the spectrum of activity for Ceftazadime (fortaz); cefpodoxime (vantin); ceftriaxone (rocephin)?
- Enteric gram negative bacteria
- Streptococci: Strep pneumo
- Pseudomonas: ONLY Ceftazidime
- MSSA: Ceftazidime poor activty
What bacteria do Ceftazadime (fortaz); cefpodoxime (vantin); ceftriaxone (rocephin) have poor or limited activity against?
- No activity for enterococci, MRSA, Listeria, stenotrophomonas
- Anaerobes: no activity against B. fragilis
3.
What is the route of administration for Ceftazadime (fortaz); cefpodoxime (vantin); ceftriaxone (rocephin)?
- Ceftazadime (fortaz): IV
- cefpodoxime (vantin): PO
- ceftriaxone (rocephin): IV
What are the clinical uses for Ceftazadime (fortaz); cefpodoxime (vantin); ceftriaxone (rocephin)?
- Ceftazadime (fortaz): pseudomonal infections, post neurosurgical meningitis, NOT community acquired meningitis
- ceftriaxone (rocephin): Community acquired pneumonia, complicated UTIs, community acquired meningitis, CSF lyme disease, strep endocarditis, gonococcal infections, PID, intra-abdominal infections with metronidazole
What are the SE of 3rd gen cephalosporins?
- Greater correlation of C. difficile infection
2. Ceftriaxone: biliary sludging esp in neonates, dose related
What are the 4th generation cephalosporins?
- Cefepime
What is the route for cefepime?
IV, IM
What gram negative bacteria is cefepime effective against?
- Aerobic gram negatives
- enterobacteriaceae
- Pseudomonas
What gram positive bacteria is cefepime effective against?
- MSSA
2. Strep. pneumo
What bacteria is cefepime NOT effective against?
- B. fragilis
- MRSA
- Listeria
What are the clinical uses for cefepime?
- Neutropenic fever
- Meningitis
- Ceftazidime-resistant enterobacteriae
What are the fifth generation cephalosporins?
Ceftaroline
What is the route for Ceftaroline?
IV
What gram positive bacteria is ceftaroline effective against?
- MRSA
- MSSA
- Streptococci
- E. caecalis
What gram negative bacteria is ceftaroline effective against?
- Enterobacteriae
- H. influenza
- M. catarrhalis
What bacteria is ceftaroline NOT effective against?
- Pseudomonas
2. Anaerobes
What are the clinical indications for ceftaroline?
Complicate skin and soft tissue infection
