DAMRA HASSAN

Definition and History of Cephalosporins The cephalosporins (sg. /sflsprn/) are a class of lactam antibiotics originally derived from the fungus Acremonium, which was previously known as "Cephalosporium".

Cephalosporin compounds were first isolated from cultures

of Cephalosporium acremonium from a sewer in Sardinia in 1948 by Italian scientist Giuseppe Brotzu. by Eli Lily in 1964.

First commercial Cephalosporin was Cephalothin launched

Molecular Structure
They are divided into 3 groups:Cephalosporin N and C are chemically related to penicillins and Cephalosporin P a steroid antibiotic resembles fusidic acid. They are classified according to the chronological order in which they were produced.

 First generation

Classification of Cephalosporins
Cefprozil Cefpodoxime loracarbef Third Generation Ceftriaxone,

Cefazolin Cephalothin Cephapirin Increased activity v Gram Negatives Cephalexin Slightly less activity Cefotaxime Cefadroxil against Gram Positives Ceftazidime Cephradine Ceftizoxime Second Generation Cefoperazone Very good Gram negative coverage Cefuroxime Reasonable against Gram Positives Cefixime Cefaclor Ceftazidime has anti-pseudomonal activity Fourth Generation Cefoxitin (cephamycin) Cefipime Cefamandole Very broad spectrum activity Fifth Generation Cefotetan including Pseudomonas Ceftobiprole Medocaril Cefmetazole

Good activity v Staphs and Streps

First Generation Cephalosporins

Effective against gram(-) &gram
(+)

Effective against gram(-) Less Effective against gram(+) Haemophilus influenza

Proteus Mirabilis E coli Krebsiella pneumonia

Clinical Conditions a. Skin and Soft Tissue Infection b. Streptococcal Pharyngitis c. Not indicated for Otitis Media

Proteus Mirabilis
E coli Krebsiella pneumonia

Clinical Conditions

1. Respiratory tract infections 2. Acute Sinusitis 3. Otitis Media

Example: Cephazolin

Examples:Cephamycins, Cefaclor, Cefuroxime

Mechanism: Spectrum of Activity

Gram Positive Cocci Less activity than First Generation Cephalosporins EKP Gram Negative Bacteria ESP Gram Negative Bacteria Better activity than First Generation Cephalosporins Better activity than Second Generation Cephalosporins No Pseudomonas activity

 Mechanism: Spectrum
of Activity
Gram Positive Cocci
Cephalosporins EKP Gram Negative Bacteria ESP Gram Negative Bacteria Better activity than First Generation Cephalosporins Better activity than Second Generation Cephalosporins No Pseudomonas activity

active against grampositive cocci

Less activity than First Generation

gram-negative bacteria P. aeruginosa

Example:Cefipime Trade Name: Maxipime

& 5th Generation.

Ceftobiprole Medocaril Activity v MRSA & PRP. Has completed Phase III trials for treatment of
soft tissue infections and HAP. Licensing probably imminent.

 Generally distributes well into the lung; kidney; urine; synovial, pleural, and
pericardial fluids. Penetration into the cerebral spinal fluid (CSF) of some 3rd generation cephalosporins(cefotaxime, ceftriaxone, and ceftazidime) is adequate to effectively treat bacterial meningitis. Elimination is primarily via the kidneys, though a few exceptions include cefoperazone and ceftriaxone which have significant biliary elimination. Metabolized in the liver

Peak: 30-60 min Duration:8-10 hrs.

Contraindications and cautions:

Adverse reactions: Nausea Allergies to cephalosporin, Vomiting diarrhea food dyes, preservatives rash Hepatic impairment Dizziness Renal impairment superinfection bone marrow depression Pregnant abdominal pain Lactating patient Headache lethargy

Cephalosporin prescribing in Renal Impairment

Most, apart from Ceftriaxone, need dose adjustment. Dont guess, consult with Pharmacist regarding correct
dosing.

With exception of Cefipime, should not be used for

treatment of Enterobacter, Serratia, Citrobacter infections due to induction of chromosomal Amp C beta-lactamases in these bacteria.

Not effective against Enterococci.

Drug to drug interaction:

Nursing considerations:

Cephalosporin with
aminoglycosides increase the risks of nephrotoxicity Cephalosporin in addition to anticoagulants experience increase bleeding Alcohol while receiving cephalosporin or 72 hrs. after receiving cause disulfiram-like reaction

Allergies to cephalosporin, Hepatic impairment Renal impairment Pregnant Lactating patient

Diagnoses: Assessment: Acute pain related to GI, CNS Assess for known allergies effect of drug Assess for history of renal and Deficient fluid volume and hepatic diseases imbalance nutrition: less than Performed physical
assessment Assess the vital signs Assess the renal function test result including the creatinine clearance Examine the injection site

body requirement, related to diarrhea Deficient knowledge regarding drug therapy Risk for infection related to repeated injection

IMPLEMENTATION:
CHECK CULTURE AND SENSITIVITY REPORTS MONITOR RENAL FUNCTION ENSURE THE THE PATIENR RECEIVE THE FULL COURSE OF CEPHALOSPORIN AS PRESCRIBED MONITOR THE SITE OF INFECTION AND PRESENTING SIGNS AND SYMPTOMS THROUGHT OUT THE COURSE OF THE THERAPY PROVIDE SMALL,FREQUENT MEALS AS TOLERATED, FREQUENT MOUTH CARE, AND CHIPS OR SUGARLESS CANDY TO SUCK IF STOMATITIS AND SORE MOUTH ARE PROBLEMS

 Patient response to the drug Adverse effects Effectiveness of the teaching plan Effectiveness of comfort and safety measures and compliance with
the therapeutic regimen.

Evaluation:

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