Cephalosporin

Aka: Cephalosporin

1. General
   1. Spectrum changes from first to third generation
      1. First Generation: Better Gram Positive Cocci coverage
      2. Third Generation: Better Gram Negative Rod coverage
2. Contraindications
   1. Drug allergy to other Cephalosporin
   2. Type I Hypersensitivity Reaction to a Penicillin
      1. Less than 10% of those who report Penicillin Allergy actually have a Penicillin Allergy
      2. Penicillin Allergy has only a 1% risk of cross-reactivity with Cephalosporins (previously thought to be 10%)
         1. Herbert (2000) West J Med 172(5): 341
      3. Penicillin Anaphylaxis confers a 0.001% risk of Anaphylaxis to Cephalosporins
         1. Apter (2006) Am J Med 119(4):354.e11-9
      4. Cross reactivity appears limited to First Generation Cephalosporins and Penicillins
         1. Second and Third Generation Cephalosporins have minimal to no allergy cross reactivity
         2. Campagna (2012) J Emerg Med 42(5): 612-20
3. Class: First Generation Cephalosporins
   1. Oral Agents
      1. Cephalexin (Keflex)
      2. Cephradine (Velosef)
      3. Cefadroxil (Duricef)
   2. Parenteral Agents
      1. Cefazolin (Ancef)
   3. Organisms covered
      1. Gram Positive Cocci
      2. EKP Gram Negative Bacteria
4. Class: Second Generation Cephalosporins
   1. Second Generation Broad-spectrum Cephalosporins
      1. Oral Agents
         1. Loracarbef (Lorabid)
         2. Cefprozil (Cefzil)
         3. Cefuroxime (Ceftin, Zinacef)
         4. Cefaclor (Ceclor)
      2. Organisms Covered
         1. Gram Positive Cocci
         2. EKP Gram Negative Bacteria
         3. Gram Negative Coccobacilli
   2. Second Generation Anti-anaerobe Cephalosporins
      1. Parenteral Agents
         1. Cefoxitin
         2. Cefotetan
         3. Cefamandole
      2. Organisms Covered
         1. Bacteroides fragilis
5. Class: Third Generation Cephalosporins
   1. Third Generation Broad-Spectrum Cephalosporins
      1. Oral agents
         1. Cefixime (Suprax)
            1. Only indication is for Gonorrhea
         2. Cefpodoxime (Vantin)
            1. Does not cover Enterobacter or pseudomonas
      2. Parenteral agents
         1. Cefotaxime (Claforan)
         2. Ceftizoxime (Cefizox)
         3. Ceftriaxone (Rocephin)
      3. Organisms Covered
         1. Gram Positive Cocci
         2. EKP Gram Negative Bacteria
         3. ESP Gram Negative Bacteria
         4. No Pseudomonas activity
   2. Third Generation Anti-Pseudomonal Cephalosporins
      1. Agents
         1. Ceftazidime (Fortaz)
      2. Organisms Covered
         1. Pseudomonas
         2. EKP Gram Negative Bacteria
         3. ESP Gram Negative Bacteria
         4. Poor Gram Positive Cocci coverage
         5. No Coccobacilli coverage
6. Dosing: Adults
   1. Almost all Cephalosporins
      1. Typical Dose: 1-2 grams IV q8h
   2. Exceptions
      1. Ceftriaxone 1-2 grams IV q24 hours
      2. Cefotetan 1-2 grams IV q12 hours
7. Dosing: Children
   1. Almost all Cephalosporins
      1. Typical dose: 100-200 mg/kg/day divided q8 hours
   2. Exceptions
      1. Ceftriaxone 75-100 mg/kg/day q24 hours
8. Reducing Adverse Effects
   1. Least Diarrhea
      1. Lorabid
      2. Ceclor
      3. Cefzil
   2. Best taste
      1. Lorabid
      2. Suprax
      3. Vantin (under age 2 years)