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Cephalosporin
Aka: Cephalosporin
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General
- Spectrum changes from first to third generation
- First Generation: Better Gram Positive Cocci coverage
- Third Generation: Better Gram Negative Rod coverage
- Contraindications
- Drug allergy to other Cephalosporin
- Type I Hypersensitivity Reaction to a Penicillin
- Less than 10% of those who report Penicillin Allergy actually have a Penicillin Allergy
- Cross reactivity was originally over-estimated as high as 10% in the 1960s
- Attributed to cross contamination from co-production of Cephalosporins and Penicillins in the same factory
- Penicillin Allergy has only an overall 1-2% risk of cross-reactivity with Cephalosporins
- Herbert (2000) West J Med 172(5): 341 [PubMed]
- Penicillin Anaphylaxis confers a 0.001% risk of Anaphylaxis to Cephalosporins
- Apter (2006) Am J Med 119(4):354.e11-9 [PubMed]
- Cross reactivity appears limited to First Generation Cephalosporins and Penicillins
- Third Generation Cephalosporins have minimal to no allergy cross reactivity
- Campagna (2012) J Emerg Med 42(5): 612-20 [PubMed]
- Aminopenicillins (Amoxicillin and Ampicillin) allergy and allergy to first and Second Generation Cephalosporins: High
- R1-side chain of Aminopenicillins are similar to first and Second Generation Cephalosporins (esp. Cefprozil, Cefadroxil)
- Reaction rate is as high as 27% for Cefadroxil
- Campagna (2012) J Emerg Med 42(5): 612-20 [PubMed]
- Class: First Generation Cephalosporins
- Oral Agents
- Cephalexin (Keflex)
- Cephradine (Velosef)
- Cefadroxil (Duricef)
- Parenteral Agents
- Cefazolin (Ancef)
- Organisms covered
- Gram Positive Cocci
- EKP Gram Negative Bacteria
- Class: Second Generation Cephalosporins
- Second Generation Broad-spectrum Cephalosporins
- Oral Agents
- Loracarbef (Lorabid)
- Cefprozil (Cefzil)
- Cefuroxime (Ceftin, Zinacef)
- Cefaclor (Ceclor)
- Organisms Covered
- Gram Positive Cocci
- EKP Gram Negative Bacteria
- Gram Negative Coccobacilli
- Second Generation Anti-anaerobe Cephalosporins
- Parenteral Agents
- Cefoxitin
- Cefotetan
- Cefamandole
- Organisms Covered
- Bacteroides fragilis
- Class: Third Generation Cephalosporins
- Third Generation Broad-Spectrum Cephalosporins
- Oral agents
- Cefixime (Suprax)
- Only indication is for Gonorrhea
- Cefpodoxime (Vantin)
- Does not cover Enterobacter or pseudomonas
- Parenteral agents
- Cefotaxime (Claforan)
- Ceftizoxime (Cefizox)
- Ceftriaxone (Rocephin)
- Organisms Covered
- Gram Positive Cocci
- EKP Gram Negative Bacteria
- ESP Gram Negative Bacteria
- No Pseudomonas activity
- Third Generation Anti-Pseudomonal Cephalosporins
- Agents
- Ceftazidime (Fortaz)
- Organisms Covered
- Pseudomonas
- EKP Gram Negative Bacteria
- ESP Gram Negative Bacteria
- Poor Gram Positive Cocci coverage
- No Coccobacilli coverage
- Dosing: Adults
- Almost all Cephalosporins
- Typical Dose: 1-2 grams IV q8h
- Exceptions
- Ceftriaxone 1-2 grams IV q24 hours
- Cefotetan 1-2 grams IV q12 hours
- Dosing: Children
- Almost all Cephalosporins
- Typical dose: 100-200 mg/kg/day divided q8 hours
- Exceptions
- Ceftriaxone 75-100 mg/kg/day q24 hours
- Reducing Adverse Effects
- Least Diarrhea
- Lorabid
- Ceclor
- Cefzil
- Best taste
- Lorabid
- Suprax
- Vantin (under age 2 years)