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.

Ontology: Cefotaxime (C0007554)

Definition (NCI) A third generation semisynthetic cephalosporin antibiotic with bactericidal activity. Cefotaxime inhibits mucopeptide synthesis by binding to and inactivating penicillin binding proteins thereby interfering with the final transpeptidation step required for cross-linking of peptidoglycan units which are a component of bacterial cell walls. This results in a reduction of cell wall stability and causes cell lysis.
Definition (MSH) Semisynthetic broad-spectrum cephalosporin.
Definition (PDQ) A third generation semisynthetic cephalosporin antibiotic with bactericidal activity. Cefotaxime inhibits mucopeptide synthesis by binding to and inactivating penicillin binding proteins thereby interfering with the final transpeptidation step required for cross-linking of peptidoglycan units which are a component of bacterial cell walls. This results in a reduction of cell wall stability and causes cell lysis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39177&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39177&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C354" NCI Thesaurus)
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002439
SnomedCT 3334000, 372704003
LNC LP14831-9, MTHU002074
English Cefotaxim, Cefotaxime, Cephotaxim, 5-Thia-1-azabicyclo(4.2.0)oct-2-ene-2-carboxylic acid, 3-((acetyloxy)methyl)-7-(((2-amino-4-thiazolyl)(methoxyimino)acetyl)amino)-8-oxo-, monosodium salt, (6R-(6alpha,7beta(Z)))-, cefotaxime (medication), Cefotaxime [Chemical/Ingredient], cefotaxim, cefotaxime, CEFOTAXIME, Cefotaxime product, Cefotaxime (product), Cefotaxime (substance)
Swedish Cefotaxim
Czech cefotaxim
Finnish Kefotaksiimi
Russian TSEFOTAKSIM, ЦЕФОТАКСИМ
Japanese セフォタキシム
Croatian CEFOTAKSIM
Polish Cefotaksym
Spanish cefotaxima (producto), cefotaxima (sustancia), cefotaxima, Cefotaxima
French Céfotaxime
German Cefotaxim
Italian Cefotaxima
Portuguese Cefotaxima
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Ceftizoxime (C0007560)

Definition (NCI) A semisynthetic, broad-spectrum, beta-lactamase-resistant, third-generation cephalosporin with antibacterial activity. Ceftizoxime binds to and inactivates penicillin-binding proteins (PBPs) located on the inner membrane of the bacterial cell wall. PBPs are enzymes involved in the terminal stages of assembling the bacterial cell wall and in reshaping the cell wall during growth and division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis.
Definition (MSH) A semisynthetic cephalosporin antibiotic which can be administered intravenously or by suppository. The drug is highly resistant to a broad spectrum of beta-lactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative organisms. It has few side effects and is reported to be safe and effective in aged patients and in patients with hematologic disorders.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D015296
SnomedCT 372770006, 54577009
LNC LP15253-5, MTHU004181
English Ceftizoxime, 5-Thia-1-azabicyclo(4.2.0)oct-2-ene-2-carboxylic acid, 7-(((2-amino-4-thiazolyl)(methoxyimino)acetyl)amino)-8-oxo-, (6R-(6alpha,7beta(Z)))-, Ceftizoxime [Chemical/Ingredient], ceftizoxime, Ceftizoxime (product), Ceftizoxime (substance), CEFTIZOXIME
Swedish Ceftizoxim
Czech ceftizoxim, cefpodoxim proxetil
Finnish Keftitsoksiimi
Russian TSEFTIZOKSIM, ЦЕФТИЗОКСИМ
Japanese セフチゾキシムナトリウム, セフチゾキシム
Croatian CEFTIZOKSIM
Polish Ceftyzoksym
Spanish ceftizoxima (producto), ceftizoxima (sustancia), ceftizoxima, Ceftizoxima
French Ceftizoxime
German Ceftizoxim
Italian Ceftizoxima
Portuguese Ceftizoxima
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Rocephin (C0035750)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002443
English Rocefin, ceftriaxone (Rocephin), rocefin, rocephin, Rocephin, Hoffman La Roche Brand of Ceftriaxone Sodium, Hoffman-La Roche Brand of Ceftriaxone Sodium, Rocefalin, Rocephine, Roche Brand of Ceftriaxone Sodium
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: cefpodoxime (C0055011)

Definition (NCI) A third generation semi-synthetic cephalosporin and a beta-lactam antibiotic with bactericidal activity. Cefpodoxime's effect is dependent on its binding to penicillin-binding proteins (PBPs) located in the bacterial cytoplasmic membrane. Binding results in the inhibition of the transpeptidase enzymes, thereby preventing cross-linking of the pentaglycine bridge with the fourth residue of the pentapeptide and interrupting consequent synthesis of peptidoglycan chains. As a result, cefpodoxime inhibits bacterial septum and cell wall synthesis formation.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C053268
SnomedCT 387534007, 96049003
LNC LP15210-5, MTHU003033
English 5-Thia-1-azabicyclo(4.2.0)oct-2-ene-2-carboxylic acid, 7-(((2-amino-4-thiazolyl)(methoxyimino)acetyl)amino)-3-(methoxymethyl)-8-oxo-, monosodium salt, (6R-(6alpha,7beta(Z)))-, cefpodoxime, CEFPODOXIME, Cefpodoxime, Cefpodoxime (product), Cefpodoxime (substance)
Spanish cefpodoxima (producto), cefpodoxima (sustancia), cefpodoxima
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Cefixime (C0060400)

Definition (NCI_NCI-GLOSS) An antibiotic drug used to treat infection. It belongs to the family of drugs called cephalosporins.
Definition (NCI) A broad-spectrum, third-generation cephalosporin antibiotic derived semisynthetically from the marine fungus Cephalosporium acremonium with antibacterial activity. As does penicillin, the beta-lactam antibiotic cefixime inhibits bacterial cell wall synthesis by disrupting peptidoglycan synthesis, resulting in a reduction in bacterial cell wall stability and bacterial cell lysis. Stable in the presence of a variety of beta-lactamases, this agent is more active against gram-negative bacteria and less active against gram-positive bacteria compared to second-generation cephalosporins.
Definition (MSH) A third-generation cephalosporin antibiotic that is stable to hydrolysis by beta-lactamases.
Definition (PDQ) A broad-spectrum, third-generation cephalosporin antibiotic derived semisynthetically from the marine fungus Cephalosporium acremonium with antibacterial activity. As does penicillin, the beta-lactam antibiotic cefixime inhibits bacterial cell wall synthesis by disrupting peptidoglycan synthesis, resulting in a reduction in bacterial cell wall stability and bacterial cell lysis. Stable in the presence of a variety of beta-lactamases, this agent is more active against gram-negative bacteria and less active against gram-positive bacteria compared to second-generation cephalosporins. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=37809&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=37809&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1100" NCI Thesaurus)
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D020682
SnomedCT 387536009, 96052006
LNC LP17701-1, MTHU005580
English cefixime, cefixime (medication), 5-thia-1-azabicyclo(4.2.0)oct-2-ene-2-carboxylicacid,7-(((2-amino-4-thiazolyl)((carboxymethoxy)imino)acetyl)amino)3-ethenyl-8-oxo-, trihydrate, (6R-(6alpha,7beta(Z)))-, Cefixime [Chemical/Ingredient], CEFIXIME, Trihydrate, Cefixime, Cefixime Trihydrate, Cefixime (product), Cefixime (substance), Cefixime
Swedish Cefixim
Czech cefixim
Finnish Kefiksiimi
Russian TSEFIKSIM, ЦЕФИКСИМ
Japanese セフィキシム
Polish Cefiksym
Spanish cefixima (producto), cefixima (sustancia), cefixima, Cefixima
French Céfixime
German Cefixim
Italian Cefixima
Portuguese Cefixima
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: cefdinir (C0060405)

Definition (NCI) A semi-synthetic cephalosporin and a beta-lactam antibiotic with bactericidal activity. Cefdinir's effect is dependent on its binding to penicillin-binding proteins (PBPs) located in the bacterial cytoplasmic membrane. Binding results in the inhibition of the transpeptidase enzymes, thereby preventing cross-linking of the pentaglycine bridge with the fourth residue of the pentapeptide and interrupting consequent synthesis of peptidoglycan chains. As a result, cefdinir inhibits bacterial septum and cell wall synthesis formation.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C056814
SnomedCT 108677001, 370366006
LNC LP19960-1, MTHU011339
English 7-(2 (2-aminothiazol-4-yl)-2-hydroxyiminoacetamido)-3-vinyl-3-cephem-4-carboxylic acid, cefdinir, CFDN, cefdinir (medication), CEFDINIR, cefdinir [Chemical/Ingredient], Cefdinir (substance), Cefdinir product (product), Cefdinir product, Cefdinir
Spanish producto con cefdinir (producto), cefdinir (producto), producto con cefdinir, cefdinir (sustancia), cefdinir
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Omnicef (C0285868)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C056814
English Omnicef, cefdinir (Omnicef), omnicef, Abbott brand of cefdinir
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Claforan (C0701052)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002439
English Claforan ADD-Vantage, claforan, Claforan, Klaforan, Aventis Brand of Cefotaxime Sodium, Aventis Pharma Brand of Cefotaxime Sodium, Hoechst Brand of Cefotaxime Sodium, Primafen
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Vantin (C0724204)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C053267
English Vantin, vantin
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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