b-lactam antibiotics (cephalosporins)

Generation Spectrum 1st Generation (Eg: Cephazolin) Broad especially Gram+ve 2nd Generation (Eg: Cefachlor) Broader especially Gram-ve 3rd Generation (Eg: Ceftriaxone) Broader especially Gram-ve 4th Generation (Eg: Cefepime) Broader especially Gram-ve 4th generation is cleared by kidney and its half life is 2 hours, useful against enterobacter Effective Highly resistant Effective

Use to Pseudomonas B Lactamase sensitivity Use to Meningitis

Not effective Resistant Not effective

Not effective Resistant Not effective

Effective Highly resistant Effective

Comparison between cephalosporins (example of B-Lactam) and vancomycin (other cell wall inhibitor)
Type Clinical uses/Therapeutic indications 1. 2. 3. 4. Cephalosporins Infections resistant to penicillin Patients allergic to penicillin Gram-ve urinary tract infections and meningitis Respiratory infection 1. 2. Vancomycin Methicillin-resistant staphylococci Used in combination with a. Gentamycin for treatment of enterococcal endocarditis in penicillin-allergic patient b. 3rd generation of cephalosporin for treatment of meningitis caused by penicillin-resistant pneumococci Irritation (phetibitis) Chills and fever Ototoxicity and nephrotoxicity especially when given with another ototoxic or nephrotoxic drugs as aminoglycosides Histamine release (allergic)

Toxicity/Adverse Effects

1. 2. 3. 4. 5.

6.

Allergic Reaction Nephrotoxicity especially cephaloridine (have been withdrawn from market) Irritant GIT upsets Cefamandol (2nd generation) and moxalactam (3rd generation) may cause severe bleeding and disulfiram-like reaction (so alcohol and alcohol-like medications should be avoided) Super infection (many 2nd and 3rd generations predispose to gram+ve infections and/or fungi)

1. 2. 3. 4.

Created by Qosru Iskandariah