Cephalosporins

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Joanna Breems
MD, FACP · Clinical Assistant Professor
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Table of Contents

Cephalexin (Keflex)

  • Class(es)

    1st-generation cephalosporin

  • Clinical use(s)

    FDA approved: Skin and soft tissue infection, osteomyelitis.
    Off-label/clinical use: Prophylaxis for bacterial endocarditis.

  • Mechanism(s) of action

    Binds to penicillin binding proteins in cell wall membrane.

  • Key adverse effects

    C. diff–associated diarrhea (CDAD), seizures (high doses especially in renal impairment)

  • Key drug/food interactions

    Concurrent use of loop diuretics or aminoglycosides may increase risk of renal toxicity.

  • Special considerations

    Can be taken with or without food. Taking cephalexin with food may decrease GI irritation. Available only in oral form (capsules, tablets, oral suspension).

Cefazolin (Ancef)

  • Class(es)

    1st-generation cephalosporin

  • Clinical use(s)

    FDA approved: Respiratory tract infections, endocarditis, intra-abdominal infections.
    Off-label/clinical use: Bacteremia associated with IV line, bacterial endocarditis (prophylaxis).

  • Mechanism(s) of action

    Bactericidal.
    Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).

  • Key adverse effects

    Diarrhea, pruritis, anaphylaxis, Stevens-Johnson syndrome.

  • Key drug/food interactions

    Warfarin (may ↑ risk bleeding).

  • Special considerations

    Renally adjusted: CrCl < 54 ml/min. Available as injectable only.

Cefotaxime (Claforan)

  • Class(es)

    3rd-generation cephalosporin

  • Clinical use(s)

    FDA approved: Bacterial meningitis, bone/joint infections, intra-abdominal infections, LRTI, SSTI.
    Off-label/clinical use: Bacterial endocarditis, Lyme disease, salmonella.

  • Mechanism(s) of action

    Bactericidal.
    Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).

  • Key adverse effects

    Diarrhea, vomiting, hypersensitivity.

  • Key drug/food interactions

    Warfarin (may ↑ risk bleeding).

  • Special considerations

    Renally adjusted: CrCl < 20 ml/min.

Cefdinir (Omnicef)

  • Class(es)

    3rd-generation cephalosporin

  • Clinical use(s)

    FDA approved: Acute bacterial otitis media, acute exacerbation chronic bronchitis, acute maxillary sinusitis, CAP, pharyngitis/tonsillitis, SSTI.
    Off-label/clinical use: Cystitis.

  • Mechanism(s) of action

    Bactericidal.
    Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).

  • Key adverse effects

    Diarrhea, nausea.

  • Key drug/food interactions

    Warfarin (may ↑ risk bleeding).

  • Special considerations

    Renally adjusted: CrCl < 30 ml/min.
    Administer at least 2 hours before or after antacids/iron supplements.

Ceftriaxone (Rocephin)

  • Class(es)

    3rd-generation cephalosporin

  • Clinical use(s)

    FDA approved: Acute otitis media, bacterial meningitis, upper/lower respiratory tract infection, UTI.
    Off-label/clinical use: Syphillus, endocarditis.

  • Mechanism(s) of action

    Bactericidal.
    Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs)

  • Key adverse effects

    Diarrhea, hypersensitivity reaction, eosinophilia.

  • Key drug/food interactions

    Calcium-containing products.

  • Special considerations

    Calcium products precipitate ceftriaxone.
    Avoid in neonates.
    Combined renal/hepatic impairment: NTE 2 grams/day.

Ceftazidime (Fortaz)

  • Class(es)

    3rd-generation cephalosporin

  • Clinical use(s)

    FDA approved: Bacterial meningitis, bacterial sepsis, pneumonia, SSTI, osteomyelitis, LRTI, UTI.
    Off-label/clinical use: Bacterial endocarditis, chronic purulent otitis media.

  • Mechanism(s) of action

    Bactericidal.
    Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).

  • Key adverse effects

    Diarrhea, anaphylaxis.

  • Key drug/food interactions

    Warfarin (may ↑ risk bleeding).

  • Special considerations

    Renally adjusted: CrCl < 50 ml/min.

Cefepime (Maxipime)

  • Class(es)

    4th-generation cephalosporin

  • Clinical use(s)

    FDA approved: Pneumonia, SSTI (uncomplicated), infectious disease of abdomen.
    Off-label/clinical use: Bacterial meningitis, infective endocarditis, peritoneal dialysis-associated peritonitis.

  • Mechanism(s) of action

    Bactericidal.
    Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).

  • Key adverse effects

    Direct positive Coombs test, diarrhea.

  • Key drug/food interactions

    Warfarin (may ↑ risk bleeding).

  • Special considerations

    Renally adjusted: CrCl < 60 ml/min.