Antibacterial Agents - Cephalosporins

Front 1

Cephalosporins characteristics?

Back 1

Broad spectrum. Good against gram + and gram - but not active against enterococci.
well tolerated
wide therapeutic window
DOC for surgical prophylaxis

Front 2

Cephalosporins not good for?

Back 2

Variable CSF penetrance
Limited against pseudomonas and resistance quick to gram -'s (ceftazadime)
Risk to give C. difficile

Front 3

First generation IV/oral cephalosporin?

Back 3

Cefazolin

ORAL: Cephalexin/Cephradine

Front 4

Second generation IV/oral cephalosporin?

Back 4

Cefoxitin
Cefuroxime

ORAL: Cefprozil

Front 5

Third generation IV/oral cephalosporin?

Back 5

Cefotaxime
Ceftriaxone
Ceftazidime
Cefepime

ORAL: Cefixime

Front 6

Cefazolin (1st gen)

Back 6

-Most active against MSSA
-Favorite of surgeons for prophylaxis and GAS.
-community acquired gram + and gram - like e.coli and klebsiella
-Penicillin susceptible streptococci like viridans strep.
-Add metronidazole to be good against intraabdominal infections
-NOT good for enterococci

Front 7

Cefamandole, Cefuroxime, Cefoxitin, Cefotetan goal? (2nd gen)

Back 7

Goal was to increase activity against H.influenzae and B.fragilis

Front 8

Cefamandole

Back 8

Increase prothrombin time. N-methylthiotetrazole (NMTT)side chain interference with prothrombin time.

Front 9

Cefuroxime

Back 9

Now used over Cefamandole. Increase activity against H. Influenzae including beta lacatamse makers.
Popular for resp infection like H.flu and M.catarrhalis

Front 10

Cefoxitin

Back 10

1st cephalosporin to be active against:
B.fragilis and N.gonorrhoeae
AND
community acquired gram -
little less active for MSSA

GOOD for intra-abdominal and pelvic infection.

Expensive so replaced with penicillin beta lacatam combinations.

Front 11

Cefotetan

Back 11

Like Cefoxitin but longer half life.
NMMT which leads to increased prothrombin.
One dose surgical prophylaxis only real use now

Front 12

Ceftriaxone, Cefatazidime goal?(3rd gen)

Back 12

Claim to fame is increase gram negative activity.
Can now be used for p.aeruginosa and avoid toxic aminoglycosides

Front 13

Ceftriaxone

Back 13

Active against all community acquired and hospital acquired gram - but NOT p.aeruginosa.
Good gram + activity including MSSA.
Pneumococci including penicillin resistant strains.
GAS, group B strep. and viridan strep.
CNS penetrates good for meningitis
Renal excretion but only adjust in endstage renal failure
UTI, CAP, sepsis, meningitis

Front 14

Avoid ceftraixone in what kind of patients?

Back 14

Neonates, use cefotaxime instead. May bind to serum proteins to displace bilrubin

Front 15

Cefatazidime

Back 15

Gives up better gram + to get better nonsocomial gram - infections.
P.aeruginosa (+aminoglycoside for synergy) and hospital acquired gram -.
Fever of uknown origin in leukopenic patients

Front 16

Cefepime (4th gen)

Back 16

Combines gram + activity of cetriaxone with gram - activity of ceftazidime.
Very broad so must watch out for selecting for resistance.
Adust dose in renal failure
For nonsocomial infections and leukopenic fever patient.

Front 17

Cephalexin & Cephradine(1st gen oral)

Back 17

Modest MSSA
Good GAS
Comminuty acquired gram -
Oral absorption good and well tolerated
Good for susceptible gram - UTI

Front 18

Cefuroxime & Cefprozil(2nd generation oral)

Back 18

Increased H.influenzae active against penicillin-susceptible s.pneumoniae.
Cefprozil tastes like gum while Cefuroxime doesn't.
Adult - Cefuroxime
Children - Cefprozil
Acute otis media DOC if allergic to amoxicillin.

Front 19

Cefixime (3rd generation)

Back 19

increase gram - but gives up pneumococcal activity
tissue gram - infection or UTI

Front 20

Cephalosporins side effects

Back 20

Primary allergic reactions
1. rashes, hives
2. anaphylaxis very rare
In patients allergic to penicillin that is delayed administer it slowly. If immediate anaphylaxis then its contraindicated.