Cephalosporins are beta-lactam antimicrobials used to manage a wide range of infections from gram-positive and gram-negative bacteria. The five generations of cephalosporins are useful against skin infection, resistant bacteria, meningitis, and other infections. This activity describes the indications, contraindications, and possible adverse effects of cephalosporins and will highlight the mechanism of action, adverse event profile, monitoring, route of administration, as well as other key factors.
Objectives:
Identify the mechanism of action of cephalosporins.
Describe the contraindications of cephalosporins.
Review the toxicity of cephalosporins.
Summarize interprofessional team strategies for improving care coordination and communication to advance cephalosporins and improve outcomes.
Indications
Cephalosporins are antimicrobials grouped into five generations based on their spectrum of coverage against gram-positive and gram-negative bacteria and their temporal discovery. First-generation cephalosporins have coverage against most gram-positive cocci as well as some gram-negative bacteria, e.g., Escherichia coli (E. coli), Proteus mirabilis, and Klebsiella pneumoniae. Second-generation cephalosporins have coverage against Haemophilus influenzae (H. influenzae), Moraxella catarrhalis, and Bacteroides spp. Third-generation cephalosporins have less coverage against most gram-positive organisms but have increased coverage against Enterobacteriaceae, Neisseria spp., and H. influenzae. Fourth-generation cephalosporins have similar coverage as third-generation cephalosporins but with additional coverage against gram-negative bacteria with antimicrobial resistance, e.g., beta-lactamase. Fifth-generation cephalosporins have coverage against methicillin-resistant staphylococci and penicillin-resistant pneumococci.
First-generation cephalosporins include cefazolin, cephalothin, cephapirin, cephradine, cefadroxil, and cephalexin. First-generation cephalosporins have active coverage against most gram-positive cocci, such as staphylococci spp. and streptococci spp., while having minimal coverage against gram-negative bacteria. Gram-negative bacteria that are more susceptible to first-generation cephalosporins are Proteus mirabilis, E. coli, and Klebsiella pneumoniae. Oral first-generation cephalosporins are commonly prescribed to use against uncomplicated skin and soft tissue infections such as cellulitis and abscesses commonly due to a Staphylococci spp. or Streptococci spp. infection. Additionally, clinicians can use them for bone, respiratory tract, genitourinary tract, biliary tract, bloodstream infection, otitis media, and surgical prophylaxis. In fact, cefazolin is the cephalosporin of choice for surgical prophylaxis. One of the non-FDA-approved indications is to use first-generation cephalosporins for endocarditis prophylaxis for those who are susceptible and undergoing a dental or respiratory procedure