Cephalosporins – Antibiotics Explained Clearly

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

kram welcome to another MedCram lecture
we’re going to talk about cephalosporins and specifically the different
generations of cephalosporins 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 the first generation of cephalosporins
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 this is going to be our gram-positive box and this is going to
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 cephalosporin
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
bacteria 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 this couple 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 ishe 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 strong gram-negative and the extra
bonuses it covers Pseudomonas so we can think of like for instance immuno
compromised patients 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 satola zane and it actually is combined with taser back town which is a
beta-lactamase inhibitor okay septal is a nasal backed ham and the other one is
seft Arlene these are very different 5th generation cephalosporins again for the
second time we have good anaerobic coverage you should know that it’s
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 Tala Zane kaizo 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 Pseudomonas F less foreign that we
currently have and they added on a Tazo back Tam which is a beta-lactamase
inhibitor so this is a super anti Pseudomonas 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 anti Pseudomonas coverages is
ceftazidime cefepime and septal is Ain okay so this is a great anti Pseudomonas
medication now what is left orally what is so good about it actually satara lean
fluoro is the trade name actually covers em are SI 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 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 gram positive staph and strep did not have
anaerobic coverage and had so-so gram-negative coverage really good for
skin and actions 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 to second generation we’ve got an aerobic
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 gram-negative coverages out of all of
the generations four generation took the best of both worlds it 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
Pseudomonas what you have to worry about in a hospital acquired infections but
also mr sa coverage with SEF terylene also something you have to worry about
in hospital acquired infections two different drugs same generation okay
well thanks for joining us you

28 thoughts on “Cephalosporins – Antibiotics Explained Clearly

  1. Wow, the general expectation and "jumping into conclusions" assumption is that the further you go down the generation, the Ceph would be getting weaker. Interesting summation of the added gram negative efficacy!!! So grateful for your video, because I had it backwards somehow prior to watching.

  2. Thank you very much. 1(gram positive) plus 3(gram negative) =4 and antipseudomonal drugs are present only among 3rd 4th 5th generations

  3. Why don't we see more prescribers use the 3rd, 4th and 5th generations which are safer than Tricyclics and Fluoroquinolones? Are they more costly?

  4. Third-generation cephalosporins should be avoided in treatment of Enterobacter infections – even if the clinical isolate appears susceptible in vitro – because of emergence of resistance.

  5. All your lectures are great and very good to help understand basics…i hope you would do a lot more videos and cover a lot more topics..i literally takes notes while playing your video and use it for revision..thank you so much!

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