Third Generation Broad-Spectrum Cephalosporins

Aka: Third Generation Broad-Spectrum Cephalosporins, Third Generation Cephalosporins, Ceftriaxone, Ceftizoxime, Cefotaxime, Cefpodoxime, Cefixime, Claforan, Rocephin, Vantin, Cefdinir, Omnicef

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II. Mechanism: Spectrum of Activity

  1. Gram Positive Cocci
    1. Less activity than First Generation Cephalosporins
  2. EKP Gram Negative Bacteria
  3. ESP Gram Negative Bacteria
    1. Better activity than First Generation Cephalosporins
    2. Better activity than Second Generation Cephalosporins
  4. No Pseudomonas activity

III. Preparations: Oral agents

  1. Cefixime (Suprax)
    1. Adult
      1. Standard: 400 mg PO divided qd to bid
      2. Gonorrhea: 400 mg PO for single dose
    2. Child: 8 mg/kg/day divided daily to twice daily
  2. Cefpodoxime (Vantin)
    1. Good activity Gram Positive organisms
      1. Covers Staphylococcus aureus
      2. Covers Pneumococcus
    2. Adult: 100 to 400 mg orally twice daily
    3. Child
      1. Pharyngitis: 10 mg/kg/day divided twice daily
      2. Otitis Media: 10 mg/kg/day taken daily
  3. Cefdinir (Omnicef)
    1. Age >13 years, Adult: 300 mg orally twice daily or 600 mg orally once daily
    2. Child <13 years old: 14 mg/kg/day divided once to twice daily

IV. Preparations: Parenteral agents

  1. Cefotaxime (Claforan)
    1. Most Staphylococcus aureus and Anaerobic activity
    2. Adult: 1 to 2 grams IM or IV every 6 to 8 hours
    3. Child
      1. Standard: 50-150 mg/kg/day IM or IV divided q4-6h
      2. Meningitis: 200 mg/kg/day IV divided q6-8h
      3. Maximum dose: 2 grams
  2. Ceftizoxime (Cefizox)
    1. Moderate Staphylococcus aureus and Anaerobic Activity
    2. Adult: 1 to 2 grams IV every 8 to 12 hours
    3. Child: 50 mg/kg/dose IV every 6 to 8 hours
  3. Ceftriaxone (Rocephin)
    1. Least Staphylococcus and Anaerobic activity
    2. Dilute in Lidocaine 1% for Intramuscular Injection
    3. In adults, 2 gram dose is preferred in >100 kg or critically ill patients
    4. Adult
      1. Standard: 1-2 grams IM or IV every 24 hours
      2. Gonorrhea: 250 mg IM single dose
    5. Child
      1. Standard: 50-75 mg/kg/day IV divided every 12-24 hours
      2. Meningitis: 100 mg/kg/day IV divided every 12-24 hours (twice daily is preferred)
      3. Otitis Media: 50 mg/kg IM single dose (max: 1g)
      4. Maximum Dose: 2 grams (4 grams for Meningitis)

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Related Studies

Cost: Medications

ceftriaxone (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
CEFTRIAXONE 1 GM VIAL Generic $1.72 each
CEFTRIAXONE 250 MG VIAL Generic $0.78 each
CEFTRIAXONE 500 MG VIAL Generic $0.94 each
cefpodoxime (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CEFPODOXIME 100 MG TABLET Generic $3.90 each
CEFPODOXIME 100 MG/5 ML SUSP Generic $1.23 per ml
CEFPODOXIME 200 MG TABLET Generic $4.99 each
cefixime (on 4/19/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CEFIXIME 100 MG/5 ML SUSP Generic $3.15 per ml
CEFIXIME 200 MG/5 ML SUSP Generic $5.95 per ml
cefdinir (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CEFDINIR 125 MG/5 ML SUSP Generic $0.29 per ml
CEFDINIR 250 MG/5 ML SUSP Generic $0.30 per ml
CEFDINIR 300 MG CAPSULE Generic $0.66 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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