Third Generation Broad-Spectrum Cephalosporin

Aka: Third Generation Broad-Spectrum Cephalosporin, Third Generation Cephalosporin, Ceftizoxime, Cefditoren, Ceftibuten

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II. Mechanism

  1. Third Generation Cephalosporins are divided into two groups
    1. Third Generation Broad-Spectrum Cephalosporin (included on this page)
    2. Third Generation Anti-Pseudomonal Cephalosporin
  2. Spectrum of Activity of broad spectrum agents
    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
      1. Contrast with Third Generation Anti-Pseudomonal Cephalosporin

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
  4. Other oral Third Generation Cephalosporins that are no longer available in the United States
    1. Cefditoren Pivoxil (Spectracef)
    2. Ceftibuten (Cedax)

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. 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)
  3. Other parenteral Third Generation Cephalosporins that are no longer available in the United States
    1. 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

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