Which medications in the drug class Cephalosporins are used in the treatment of Bacterial Pneumonia?

Updated: Sep 30, 2020
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Cephalosporins

Cefepime (Maxipime)

Cefepime is the best beta-lactam for IM administration. This agent is a fourth-generation cephalosporin that has gram-negative coverage comparable to ceftazidime but with better gram-positive coverage (comparable to ceftriaxone). Cefepime is a zwitter ion, so it rapidly penetrates gram-negative cells. However, this agent has a poor capacity to cross the blood-brain barrier, which precludes its use for the treatment of meningitis.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It acts by arresting bacterial cell wall synthesis by binding to one or more penicillin-binding proteins, which, in turn, inhibits bacterial growth. Cefotaxime is used for septicemia and treatment of gynecologic infections caused by susceptible organisms, but it has a lower efficacy against gram-positive organisms.

Cefuroxime (Ceftin, Kefurox, Zinacef)

Cefuroxime is a second-generation cephalosporin that maintains gram-positive activity of first-generation cephalosporins, as well as adds activity against P mirabilis, H influenzae, E coli, K pneumoniae, and M catarrhalis. This agent binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death.

The condition of patient, severity of infection, and susceptibility of microorganism determine the proper dose and route of administration. Cefuroxime resists degradation by beta-lactamase.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It acts by arresting bacterial cell wall synthesis by binding to one or more penicillin-binding proteins, which, in turn, inhibits bacterial growth. Cefotaxime is used for septicemia and treatment of gynecologic infections caused by susceptible organisms, but it has a lower efficacy against gram-positive organisms.

Cefuroxime (Ceftin, Kefurox, Zinacef)

Cefuroxime is a second-generation cephalosporin that maintains gram-positive activity of first-generation cephalosporins, as well as adds activity against P mirabilis, H influenzae, E coli, K pneumoniae, and M catarrhalis. This agent binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death.

The condition of patient, severity of infection, and susceptibility of microorganism determine the proper dose and route of administration. Cefuroxime resists degradation by beta-lactamase.

Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime)

Ceftazidime is a third-generation cephalosporin with broad-spectrum, gram-negative activity, including Pseudomonas; low efficacy against gram-positive organisms; and high efficacy against resistant organisms. This agent arrests bacterial growth by binding to one or more penicillin-binding proteins, which, in turn, inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall synthesis, thus inhibiting cell wall biosynthesis.

The condition of the patient, severity of infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Ceftazidime/avibactam (Avycaz)

This combination is indicated for hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) caused by the following susceptible Gram-negative microorganisms: Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Serratia marcescens, Proteus mirabilis, Pseudomonas aeruginosa, and Haemophilus influenzae in patients aged 18 years or older.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity; low efficacy against gram-positive organisms; and high efficacy against resistant organisms. It is considered the drug of choice for parenteral agents in community-acquired pneumonia. Bactericidal activity results from inhibiting cell wall synthesis by binding to one or more penicillin binding proteins. This agent exerts its antimicrobial effect by interfering with the synthesis of peptidoglycan, a major structural component of the bacterial cell wall. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes while the cell wall assembly is arrested.

Ceftriaxone is highly stable in presence of beta-lactamases, both penicillinase and cephalosporinase, and of gram-negative and gram-positive bacteria. Approximately 33-67% of the dose excreted unchanged in urine, and the remainder is secreted in bile and, ultimately, in feces as microbiologically inactive compounds. This agent reversibly binds to human plasma proteins, and binding has been reported to decrease from 95% bound at plasma concentrations of less than 25 mcg/mL to 85% bound at 300 mcg/mL.

Ceftolozane/tazobactam (Zerbaxa)

Ceftolozane is a cephalosporin that has demonstrated potent in vitro activity against Pseudomonas aeruginosa. Tazobactam is a beta-lactamase inhibitor. It is indicated for treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) caused by the following susceptible gram-negative microorganisms: Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Serratia marcescens.

Ceftaroline (Teflaro)

Ceftaroline is a fifth-generation cephalosporin indicated for community-acquired bacterial pneumonia and for acute bacterial skin and skin structure infections, including methicillin-resistant Staphylococcus aureus (MRSA). This agent is a beta-lactam cephalosporin with activity against aerobic and anaerobic gram-positive and aerobic gram-negative bacteria. It demonstrates activity in vivo against resistant MRSA strains and activity in vitro against vancomycin-resistant and linezolid-resistant S aureus

Cefprozil (Cefzil)

Cefprozil binds to one or more of the penicillin-binding proteins, inhibiting cell wall synthesis and resulting in bactericidal activity. Use this agent with caution in patients with renal impairment (coadministration with furosemide and aminoglycosides increases nephrotoxic effects). Probenecid coadministration also increases the effect of cefprozil

Cefiderocol (Fetroja)

Cefiderocol is a cephalosporin antibiotic that is capable of penetrating outer cell membranes of Gram-negative bacteria by acting as a siderophore. It is indicated for hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) caused by the following susceptible Gram-negative microorganisms: Acinetobacter baumannii complex, Escherichia coli, Enterobacter cloacae complex, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Serratia marcescens


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