Cephalosporin Antibiotics: Clear Chart With Each Generation!
20
October

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , , , , , , /


welcome to another MedCram lecture
we’re going to talk about cephalosporins and specifically the different
generations some representative antibiotics in each class and what are
the unique things about those generations and what they do in their
coverage so there are five generations of cephalosporins we’ve got the first
generation cephalosporin we’ve got the second which we’ll talk about the third
which is the workhorse of the pneumonia scene we’ve got the fourth generation
which has got the Pseudomonas coverage so also in the third and then finally
the fifth which is an interesting generation that we’ll talk about as we
go from first the second to third to fourth you’ll see that there is better
and better gram-negative coverage so at the very beginning with the first
generation cephalosporins we have medications like cefazolin and
cephalexin and these antibiotics really have no anaerobic coverage so no an
aerobic coverage but what they did have a lot of coverage for is gram-positive
so this is gonna be our gram-positive box and this is gonna be our
gram-negative box so in terms of gram positives it had really good staff and
actually pretty good strap coverage so where do we see these things being used
we see these things being used in for instance skin infections because this
has got really good gram-positive coverage no anaerobic coverage good
staph and strep and in terms of gram-negative it would still take care
of you know your regular gram negatives like e.coli like Proteus and like
Klebsiella okay when they went on to second generation cephalosporins here
we’re talking about medications like cefuroxime and likes fot ten
so the biggest thing about this was that now we had an aerobic coverage that was
the big thing and so as a result of that we’re now we’re looking at
intra-abdominal and the reason why we could do that was because there’s a lot
of anaerobic bacterial intra-abdominal ewwww but in terms of the staph and
strep it stayed the same going from the first generation to the second there was
really no change so we didn’t lose much in terms of staph and strep but going
from first generation the second generation we actually got a little bit
better gram-negative coverage so that’s what really made it really well in terms
of intra-abdominal infections the second generation was better in terms of that
okay let’s go on to the third generation third generation cephalosporins
there’s three major examples and you should know these one of them is
ceftriaxone the other one is cefotaxime and the last
one is a very important one called ceftazidime we’ll talk about that one a
little bit in terms of anaerobic coverage well it lost it again
so not anaerobic no anaerobic coverage here whereas we had it back in the
second generation now in terms of gram positives here it was okay definitely
very good in pneumococcus okay but in terms of staff probably not as good a
coverage in terms of staph aureus because it has good pneumococcal
coverage third-generation cephalosporins were really good at lung lung infection
so we’re talking about community-acquired pneumonia now there’s
a couple of things I should mention here and that’s very specifically that
ceftazidime is covering Pseudomonas and that’s an important thing that we’re
going to have to bring up here when we talk about gram negatives is that here
it’s even better you can see as we go up the list
here in terms of generations that the gram-negative coverage just keeps
getting better specifically if you’re using ceftazidime
you can now cover Pseudomonas but even if you’re not we’re talking good
coverage with Neisseria gonorrhea we’re talking about Enterobacter ìshe so
enterobacter we’re talking about Serratia so Enterobacter Serratia a
Neisseria gonorrhea it’s better and here’s the big one if you use
ceftazidime it’ll cover Pseudomonas now that’s a big one because Pseudomonas is
the infection that people get in nursing homes specifically in their lung so
that’s third generation probably one of the best up to that point in terms of
gram-negative coverage now fourth generation the big one that you got to
know there is cefepime now cefepime is important because it also covers the big
p the big Pseudomonas okay in terms of anaerobic coverage still no anaerobic
coverage so so far the only one that actually covers anaerobes is the second
generation cephalosporins now the fourth generation cephalosporins were something
quite amazing because what it did is it took the strength of the first
generation for gram positives okay so really strong and it added the great
gram negative coverage of the third and made it strong
so cefepime is really outstanding and so what were we using these for we were
using these for very serious infections anywhere so I’ll put serious here
because it’s got excellent coverage strong gram positive Strom gram negative
and the extra bonuses it covers Pseudomonas so we can think of
like for instance immunocompromised patience or fever of unknown origin okay
so this fourth generation cephalosporin had excellent excellent coverage now
when we go to the fifth generation the fifth generation cephalosporin is kind
of unusual because we’ve got different players in that generation which are
very very different from each other the first one that I want to talk to you
about is a long one called sift all is Ain and it actually is combined with
taser baktun which is a beta-lactamase inhibitor okay Saif attalos aim heizo
backed him and the other one is sift Harleen these are very different 5th
generation cephalosporins again for the second time we have good anaerobic
coverage you should know that should really just the second generation and
the fifth generation that have an aerobic coverage but let’s talk a little
bit more about these two players ACEF tall the same Tazo back down this
first one what they did was they took ceftazidime okay that structure and they
basically made it better and so that this is the actually the most potent
anti suit ammonal cephalosporin that we currently have and they added on a Tazo
back Tam which is a beta-lactamase inhibitor so this is a super anti
sunomono that works well so just to review we’ve got three cephalosporins
that have anti sunomono coverage and i think that’s important to know you
should know that ceftazidime cefepime and seth tall is a nar now we use
ceftriaxone as our third-generation cephalosporin to treat
community-acquired pneumonia notice that ceftriaxone or Rocephin does
not have any anti sunomono coverage so if a patient is coming in from a nursing
home or some institution or a hospital that they’re at risk for having
Pseudomonas you should not use ceftriaxone do not use ceftriaxone
because ceftriaxone has no anti-suit ammonal coverage the only one that has
pseudomonas coverages is ceftazidime cefepime and cept Allah Zayn okay so
this is a great anti sunomono medication now what is Saif Tarly what is so good
about it actually satara lean the fluoro is the trade name actually covers em are
sa it is the only cephalosporin that can actually treat mr si okay so that’s
pretty important it’s currently indicated for skin and soft-tissue
infections and also community-acquired pneumonia it has not as of this taping
gotten the FDA approval for Mrs a pneumonia one other bit of advice
information I want to give you is sometimes when they’re actually testing
bacteria like gram negatives for cefepime they’ll notice that it is
sensitive to cefepime but it’s not sensitive to any other
cephalosporin this you should think about in terms of if it is possible to
be an extended spectrum beta lactamase if they are you should not use any
cephalosporins whatsoever and should switch to the mono lactam and we’ll talk
about that in one of our next lectures so just to review again here we’ve got
the first second third fourth and fifth generation the first generation was
really good on grand positive staph and strep did not have anaerobic coverage
and had so-so gram-negative coverage really good for skin infections like
cefazolin cephalexin okay but because it had good
gram-negative coverage like e-coli you could use it in simple urinary tract
infections going into second generation we’ve got anaerobic coverage we’ve got
better gram-negative coverage this is intra-abdominal because of that
anaerobic and better gram-negative coverage third generation is the
workhorse for community-acquired pneumonia because of the ceftriaxone but
you should also know that it also holds ceftazidime which is an anti-suit
ammonal and it’s got one of the best grande negative coverages out of all of
the generations four generation took the best of both worlds
took the first-generation gram-positive coverage and it took the
third-generation gram-negative coverage put it all together and you got cefepime
which is anti pseudo monel okay so it was for serious infections where
you needed really good broad-spectrum antibiotics finally the fifth generation
has two odd players that are really different from each other
SEF tolas ain which is the anti pseudo monel which you have to worry about in
in a hospital-acquired infections but also mrs a coverage with sift Harleen
also something you have to worry about in hospital acquired infections two
different drugs same generation okay well thanks for joining us


4 thoughts on “Cephalosporin Antibiotics: Clear Chart With Each Generation!

  1. See the complete MedCram antibiotics series and get 3 hours of CME / CE: https://www.medcram.com/courses/Antibiotics-Explained-Clearly

  2. Very relevant. I just finished a 3 day course of ceftriaxone shots for facial cellulitis caused by a dental abscess. I was just thinking last night I should read up on cephalosporins. Imagine my surprise when I saw this in my subscription feed. Thanks for making this. Cheers!

  3. Great video ! I use to watch your videos during pharmacy school … to be honest it saved me ! Thank you.

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