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Cephalosporin

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Cephalosporin

  • 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
  • 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. Cross reactivity was originally over-estimated as high as 10% in the 1960s
      1. Attributed to cross contamination from co-production of Cephalosporins and Penicillins in the same factory
    3. Penicillin Allergy has only an overall 1-2% risk of cross-reactivity with Cephalosporins
      1. Herbert (2000) West J Med 172(5): 341 [PubMed]
    4. Penicillin Anaphylaxis confers a 0.001% risk of Anaphylaxis to Cephalosporins
      1. Apter (2006) Am J Med 119(4):354.e11-9 [PubMed]
    5. Cross reactivity appears limited to First Generation Cephalosporins and Penicillins
      1. Third Generation Cephalosporins have minimal to no allergy cross reactivity
      2. Campagna (2012) J Emerg Med 42(5): 612-20 [PubMed]
    6. Aminopenicillins (Amoxicillin and Ampicillin) allergy and allergy to first and Second Generation Cephalosporins: High
      1. R1-side chain of Aminopenicillins are similar to first and Second Generation Cephalosporins (esp. Cefprozil, Cefadroxil)
      2. Reaction rate is as high as 27% for Cefadroxil
      3. Campagna (2012) J Emerg Med 42(5): 612-20 [PubMed]
  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
  • 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
  • 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
  • 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)