Cephalosporins

• Class of β-lactam antibiotics
• Cephamycins (cefoxitin and relatives) are commonly included under second-generation cephalosporin
  • Narrower spectrum but resistance to β-lactamases
• Organized into generations, with increasing generations having broader gram-negative coverage but losing some gram-positive coverage
• Third-generation are considered extended-spectrum; therefore, β-lactamases that hydrolyze third-generation cephalosporins are called extended-spectrum β-lactamases

Generation	Antibiotic	Route	Notes
First	cefadroxil	PO
	cefazolin	IV
	cephacetrile
	cephalexin	PO
	cephaloridine
	cephalothin	IV	previously used to predict cefazolin susceptibilty
	cephapirin
	cephradine	PO/IV
Second	cefaclor	PO
	cefamandole
	cefonicid
	ceforanide
	cefotiam	PO/IV
	cefprozil	PO	sometimes thought of as a third-generation
	cefuroxime	PO/IV
	cefuzonam		severe skin reactions
	loracarbef	PO
Cephamycins	cefmetazole
	cefotetan
	cefoxitin
	flomoxef
Third	cefdinir	PO
	cefditoren	PO
	cefixime	PO
	cefoperazone	IV	coformulated with sulbactam
	cefotaxime	IV	very similar to ceftriaxone
	cefpiramide		sometimes described as a fourth-generation; may be active against Pseudomonas aeruginosa
	cefpodoxime	PO
	cefsulodin	PO	sometimes described as a fourth-generation; may be active against Pseudomonas aeruginosa
	ceftazidime	IV	active against Pseudomonas aeruginosa; may be coformulated with avibactam
	ceftibuten	PO
	ceftizoxime
	ceftriaxone	IV
Fourth	cefepime	IV	active against Pseudomonas aeruginosa and AmpC producers
	cefpirome
Fifth	ceftaroline	IV	active against MRSA; may be coformulated with avibactam
	ceftobiprole	IV	active against MRSA
	ceftolozane	IV	coformulated with tazobactam; active against Pseudomonas aeruginosa and ESBL producers
Siderophore	cefiderocol	IV

Further Reading

• Comparison of various cephalosporins at Antimicrobe. http://www.antimicrobe.org/d19tab1.htm