There are hundreds of antimicrobials on the market today used to treat infectious organisms. One commonly prescribed class of antibiotics is cephalosporins, a type of beta-lactam antibiotic, that covers a broad range of organisms (Letourneau, 2022). Let’s look at cephalosporins and how they work.
How Do Cephalosporins Work?
Bacteria grow and replicate by creating a cell wall using cross-linking peptidoglycan (sugar and amino acid) units and penicillin-binding proteins (PBP, peptidoglycan transpeptidase) (Bui & Preuss, 2023). Using their beta-lactam ring structure, cephalosporins incorporate themselves into the cell wall of a susceptible, mature, gram positive or gram negative bacterium. It binds to one or more of the penicillin-binding proteins, preventing cell wall construction, leading to cell death (Bui & Preuss, 2023; Facts and Comparisons, 2023).
Generations of Cephalosporins
Cephalosporins are subcategorized into five “generations” of antibiotics based on their activity against aerobic and gram-negative bacilli as well as gram-positive bacteria.
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Cephalosporins
(Bui & Preuss, 2023; Letourneau, 2022)
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Classification
*Not marketed in the United States |
Spectrum of Activity |
General Indications |
First Generation
Parenteral
- Cefazolin (Ancef, Kefzol)
- Cephalothin (Keflin, Seffin)*
- Cephapirin (Cefadyl)*
- Cephradine (Velosef)*
Oral
- Cefadroxil (Duricef, Ultracef)
- Cephalexin (Keflex, Biocef, Keftab)
- Cephradine (Velosef)*
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- Most gram-positive cocci
- Staphylococcus
- Streptococcus
- Some gram-negative bacteria
- Escherichia coli (E. coli)
- Proteus mirabilis (P. mirabilis)
- Klebsiella pneumoniae
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- Uncomplicated skin and soft tissue infections (i.e., cellulitis, abcesses)
- Infections:
- Bone and joint
- Respiratory tract
- Genitourinary tract
- Biliary tract
- Bloodstream (septicemia)
- Skin
- Otitis media
- Surgical prophylaxis
- Endocarditis
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Second Generation
(including cephamycin subgroup)
Parenteral
- Cefamandole (Mandol)*
- Cefonicid (Monocid)*
- Cefuroxime (Kefuorx, Zinacef)
Cephamycin subgroup
- Cefmetazole (Zefazone)*
- Cefotetan (Cefotan)
- Cefoxitin (Mefoxin)
Oral
- Cefaclor (Ceclor)
- Cefprozil (Cefzil)
- Cefuroxime-axetil (Ceftin)
- Loracarbef (Lorabid)*
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- Haemophilus influenzae
- Moraxella catarrhalis
- Enterobacter aerogenes
- Neisseria
- Serratia marcescens
Cephamycin subgroup:
- Bacteroides
- E. coli
- P. mirabilis
- Klebsiella
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- Similar indications to first generation cephalosporins
- Lyme disease in pregnant women and children
- Respiratory infections, such as bronchiolitis or pneumonia
- Prophylaxis of infection in abdominal and pelvic cavities
Oral:
- Otitis media
- Respiratory tract infections
- Urinary tract infections
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Third Generation
Parenteral
- Cefoperazone (Cefobid)*
- Cefotaxime (Claforan)
- Ceftazidime (Fortaz)
- Ceftizomine (Cefizox)*
- Ceftriaxone (Rocephon)
- Moxalactam*
Oral
- Cefdinir (Omnicef)
- Cefditoren (Spectracef)*
- Cefixime (Suprax)
- Cefpodoxime-poxetil (Vantin)
- Ceftibuten (Cedax)*
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- When given IV, penetrate blood-brain barrier and treat infection in cerebral spinal fluid
- Entero-bacterales (E. coli, P. mirabilis, indole-positive Proteus, Klebsiella, Enterobacter, Serratia, Citrobacter)
- Neisseria
- H. influenzae
- Pseudomonas aeruginosa (P. aeruginosa)
- Streptococcus pneumoniae
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- Meningitis (gram-negative)
- Meningitis in children
- Gonorrhea (penicillin-resistant)
- Lyme disease involving central nervous system or joints
Oral
- Otitis media
- Urinary tract infections
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Fourth Generation
Parenteral
- Cefepime (Maxipime)
- Cefpirome (Cefrom)*
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- Similar activity as third generation
- Cefepime can penetrate cerebral spinal fluid
- Beta-lactamase-producing gram-negative bacilli
- P. aeruginosa
- Methicillin-sensitive Staphylococcus aureus (MSSA)
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- Neutropenia (febrile)
- Intraabdominal, skin, and urinary tract infections
- Pneumonia
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Fifth Generation and
Combination Agents
Parenteral
- Ceftaroline (Teflaro)
- Cefiderocol (Fetroja)
- Ceftobiprole (Zeftera)*
Combination agents
- Ceftolozane-tazobactam (Zerbaxa)
- Cefazidime-avibactam (Avycaz, Zavicefta)
- Cefoperazone-sulbactam*
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- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin-intermediate Staphylococcus aureus (VISA)
- Enterococcus faecalis
- Listeria monocytogeneses
- Penicillin-resistant Streptococcus pneumoniae
- H. influenzae
- M. catarrhalis
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- Soft tissue infections
- Community-acquired pneumonia
- Healthcare-associated or ventilator-associated pneumonia
- Complicated urinary tract infections, including pyelonephritis
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Nursing Considerations (Letourneau, 2022; Bui & Preuss, 2023)
Cephalosporins are the most common beta-lactam antibiotics. Nurses should consider the following when administering these antimicrobials to their patients.
- Most parenteral cephalosporins have a short serum half-life requiring more frequent dosing. Cefazolin and ceftriaxone have longer half-lives and do not require frequent dosing.
- For patients with severe renal failure, dosing of cephalosporins (except ceftriaxone) will require adjustment. The total daily dose should not exceed 2 grams in patients with both renal and hepatic failure.
- Staphylococcus aureus (S. aureus) can develop resistance to cephalosporins by changing the structure of their PBPs. These are known as methicillin-resistant S. aureus (MRSA) and are susceptible to 5th generation cephalosporins.
- Common adverse reactions include nausea, vomiting, reduced appetite, and stomach pain. Less common adverse reactions include drug-induced immune hemolytic anemia (DIIHA), vitamin K deficiency, nephrotoxicity, and pseudomembranous colitis.
- Cephalosporins are contraindicated in patients with prior allergic reactions or who may have an anaphylactic reaction to penicillin or other beta-lactam drugs, neonates with hyperbilirubinemia which may cause jaundice, and nfants less than 28 days old if expected to receive calcium-containing products.
- Cefepime toxicity can cause seizures and encephalopathy.
For complete information, please consult the drug’s specific package insert or the
Nursing2024 Drug Handbook® + Drug Updates.
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