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Questions and Answers
What type of bacteria are third-generation cephalosporins effective against?
Which of the following is NOT a characteristic of third-generation cephalosporins?
What is a concern when using third-generation cephalosporins?
What type of infection is Ceftaroline indicated for?
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Which of the following is a fourth-generation cephalosporin?
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What is required to administer Cefepime?
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What type of laboratory testing is required to select an antibiotic against B. aeruginosa?
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What type of bacteria is Ceftaroline active against?
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What is the unique feature of ceftaro/ine that allows it to bind to PBPs?
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What is a limitation of ceftaro/ine's use?
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What are the two main mechanisms of resistance to cephalosporins?
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Which of the following bacteria is not covered by ceftaro/ine?
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How are many cephalosporins typically administered?
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Which cephalosporins achieve adequate therapeutic levels in the CSF?
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Study Notes
Cephalosporins
- Third-generation cephalosporins have enhanced activity against gram-negative bacilli, including β-lactamase producing strains of H. influenzae and Neisseria gonorrhoeae.
Spectrum of Activity
- Third-generation cephalosporins are active against enteric organisms, such as Serratia marcescens and Providencia species.
- Ceftriaxone and cefotaxime are agents of choice in the treatment of meningitis.
- Ceftazidime has activity against P. aeruginosa, but resistance is increasing and use should be evaluated on a case-by-case basis.
Precautions
- Third-generation cephalosporins must be used with caution due to "collateral damage," including the induction of antimicrobial resistance and development of Clostridium difficile infection.
Fourth-Generation Cephalosporins
- Cefepime is a fourth-generation cephalosporin and must be administered parenterally.
- Cefepime has a wide antibacterial spectrum, with activity against streptococci and staphylococci (but only methicillin-susceptible strains).
- Cefepime is effective against aerobic gram-negative organisms, such as Enterobacter species, E. coli, K. pneumoniae, B. mirabilis, and B. aeruginosa.
Advanced-Generation Cephalosporins
- Ceftaroline is a broad-spectrum, advanced-generation cephalosporin with activity against MRSA.
- Ceftaroline is indicated for the treatment of complicated skin and skin structure infections and community-acquired pneumonia.
- Ceftaroline has broad gram-positive activity and similar gram-negative activity to ceftriaxone.
- Important gaps in coverage include B. aeruginosa, ESBL-producing Enterobacteriaceae, and Acinetobacter baumannii.
Resistance
- Resistance to cephalosporins is due to hydrolysis of the β-lactam ring by β-lactamases or reduced affinity for PBPs.
Pharmacokinetics
- Many cephalosporins must be administered IV or IM due to poor oral absorption.
- Cephalosporins distribute well into body fluids, but only a few achieve adequate therapeutic levels in the CSF.
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Description
This quiz covers the third-generation cephalosporins, their activity against gram-negative bacilli, and their use in treating meningitis. Learn about the spectrum of activity and choice of agents for treatment.
