Cephalosporin antibiotics, classification and using.
The cephalosporin antibiotics are the largest and most diverse group of beta-lactam antibiotics. There are five classes of cephalosporins and some other antibiotics which have not been assigned to a particular generation.
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Using of different Generations:
First Generation:
Uncomplicated skin and soft-tissue infections, uncomplicated urinary tract infections, streptococcal pharyngitis, surgical prophylaxis. First generation cephalosporins do not penetrate well into the cerebral spinal fluid and are not good for CNS infections. NOT indicated for otitis media.
Second Generation:
Upper and lower respiratory tract infections, acute sinusitis,
otitis media, uncomplicated urinary tract infections. Cephamycins are useful for mixed aerobic/anaerobic infections of the skin and soft tissues, intra-abdominal, and gynecologic infections, and surgical prophylaxis.
Second generation cephalosporins don't cross the blood-brain barrier and are NOT used for CNS infections.
Third Generation:
Gram-negative bacillary meningitis,serious infections of Enterobacteriaceae, upper respiratory tract infections, otitis media, pyelonephritis, skin and soft tissue infections. Ceftriaxone is indicated for Lyme disease and gonorrhea.
Cefotaxime, ceftazidime, ceftriaxone, ceftizoxime, and moxalactam have excellent penetration into the cerebrospinal fluid.
Enterobacter species have a tendency to become resistant during cephalosporin therapy, and thus cephalosporins are not the drugs of choice for Enterobacter infections.
AntiPseudomonal Cephalosporins
Ceftazidime (Fortaz, Tazicef, Tazidime) and Cefoperazone (Cefobid) are the two third generation cephalosporins with antipseudomonal activity.
Spectrum of activity:
Pseudomonas aeruginosa - main indication.
Gram-negative bacteria: Enterobacteriaceae covered by the 3rd generation agents.
Poor activity against Gram-positive Cocci.
- ceftaroline fosamil (Teflaro)
- ceftobiprole (Zeftera, Zevtera)
Ceftaroline is unique in its activity against multidrug-resistant Staphylococcus aureus, including MRSA, VRSA, and VISA. Ceftaroline is the ONLY beta-lactam with MRSA activity. It is also active against Enterococcus.
Ceftobiprole is a very broad-spectrum cephalosporin with activity against gram-positive cocci, including MRSA and methicillin-resistant Staphylococcus epidermidis (MRSE), penicillin-resistant Streptococcus pneumoniae, Enterococcus faecalis and many gram-negative bacilli including AmpC producing E. coli and Pseudomonas aeruginosa. It is investigated in the treatment of complicated skin and skin structure infections.
