Cephalosporins

S. Gayathri Shree
2nd Year MBBS
What are Cephalosporins...?

 Cephalosporium acremonium – First source

 Nucleus – 7- aminocephalosporanic acid
 Classification – 5 Generations – Based on Antibacterial Spectrum
 MOA – Cell wall synthesis inhibitors
 Excretion through Tubular secretion and Biliary tract
 Route – Oral and Parenteral ( IV, IM )
Beta lactam Ring

7th position - Anti bacterial

activity

3rd position –
Pharmacokinetic and
metabolic property
Dihydrothiazine ring
Case Scenario

60 years old female came to OPD with

C/O Headache, Burning Micturition, Abdominal pain for past 20 days.
Presented with fever, chills and rigors
K/C/O Type 2 DM for past 20 years
She was admitted in M3 female ward on 10th August 2022
On Examination

 B/L toe Amputation RADIOLOGICAL FINDINGS

 Frontal and Maxillary sinus  Minimal ascites
tenderness (+)
 Cystitis
 Nasal septum deviated to Rt
 B/L Increased renal echos
side
 GB Sludge (+)
 Suprapubic tenderness (+)
Treatment
 Inj.Human mixtard S/C ½ an hr B/F
 Inj.Human actrapid S/C ½ an hr B/F
 Tab.Metformin 500mg BD × 8 days
 Tab.Glibenclamide 5mg BD× 3 days
 Inj.Ceftriaxone 1g i.v.b.d × 8 days
 Tab.Ranitidine 50mg i.v.b.d × 8 days
 Tab.Paracetamol 500mg TDS × 8 days
 Tab.Amytryptaline 25mg OD × 8 days
 Tab.Cetrizine 10mg OD × 6 days
 Nitrofurantoin 100mg BD × 5 days
 Betahistine 8mg TDS × 3 days
Ceftriazone

 Third generation Cephalosporin

 Excreted through Bile – No dosage adjustment in renal insufficiency
 Crosses BBB – Good CSF concentration
 Longer Duration of action (Half life 7- 8 hr)
Dose – Ceftriazone IV

Adult Dose – 1 – 4g q24h

 Pediatric dose – 50-100mg/kg/d in 1 or 2 doses
 Neonatal dose – 50 mg/kg/d qd
DOC Adverse Effects:

 Gonorrhoea  Diarrhoea
 Salmonellosis  Hypoprothrombinaemia-
 E.coli Bleeding
 Proteus  Hyperbilirubinemia – Jaundice
 Haemophilus  Pseudolithiasis
 Bacterial Meningitis
 Penicillin Resistant Pneumococci
Methylthiotetrazole
Monotherapy given for Gonorrhoea

IM Ceftriazone + Azithromycin
Empirical Therapy before Bacterial diagnosis

Ceftriazone + ( Ampicillin+/ Vancomycin )

Meningitis by Penicillin resistant Pneumococci

 Which Organism that causes Meningitis is not
susceptible to Ceftriaxone/Cefotaxime ?

Listeria monocytogenes
 Pneumococci
 Meningococci
 H.influenzae
 Enteric GN rods
Can you Prescribe Cephalosporins to a Patient with
H/O Penicillin anaphylaxis ?

 Increased risk
 Chemical Nucleus sufficiently different – Tolerable
 Cross Resistance ~1%
 Penicillin,amino Penicillin,1st & 2nd Gen Cephalosporins
 3rd & 4th Gen Cephalosporins - Monitor
Alternate drug for Syphilis

Ceftriaxone 1g IM OD 10-14 days

How will you treat Bleeding due to
Ceftriazone?

Oral administration Vitamin K1 10mg weekly twice

THANK YOU