What is cephalosporins allergy

Cefuroxime, cefotiam and cefaclor are significant substances of the second generation of Cephalosporins.

Antibiotic Spectrum of Second Generation Cephalosporins

Good activity against streptococci, gonococci, meningococci, Haemophilus and staphylococci. High β-lactamase resistance. No efficacy against Pseudomonas, enterococci, mycoplasma, chlamydia.

Side Effects of Cefuroxime

  1. Allergy: 1–4%. There is a minimal risk for cross-allergy to penicillin.
  2. Positive direct Coombs test, extremely rarely hemolytic anemia.
  3. Allergic neutropenia
  4. Inhibiting the effect of anticoagulants or antiplatelet agents

Urologic Indications of Cefuroxime:

  1. Urinary tract infection
  2. Wound infection
  3. Treatment of gonorrhea
  4. Staphylococci infections
  5. Perioperative antibiotic prophylaxis
  6. Cefuroxime can replace penicillin in a penicillin allergy.

Pharmacokinetics of Cefuroxime and Cefotiam

Cefuroxime can be applied per os or intravenously. Elimination half life 1 h. 70–90% renal elimination.

Contraindications of Cefuroxime

Cephalosporin allergy.

Dosage of Cefuroxime and Cefotiam

In urinary tract infections: cefuroxime 250–500mg 1-1-1 p.o., 750mg 1-1-1 i.v.

What is cephalosporins allergy

or 1 g cefotiam 1-1-1 i.v., depending on severity of infection Ovalle et al. 2000. Children get 25mg/kg i.v. 1-1-1. In severe infections the dosage is doubled. Dose reduction is necessary in renal insufficiency.


Cephalosporins: Four Generations of Beta-Lactam Antibiotics

Review literature: (Simon and Stille, 1997).


Cefazolin

Antibiotic Spectrum of Cefazolin

Cefazolin is a first-generation cephalosporin.

Cefazolin has a comparable antibiotic spectrum as penicillin. In addition, cefazolin has activity against gram-negative bacteria (E. coli, Klebsiella) and staphylococci.

Side Effects of Cefazolin

  1. Allergy: 1–4%. Normally, there is a little risk for cross-allergy to penicillin (10%)
  2. Positive direct Coombs test, extremely rarely hemolytic anemia.
  3. Allergic neutropenia
  4. Inhibiting the effect of anticoagulants or antiplatelet agents

Urologic Indications for Cefazolin

  1. Staphylococci infections
  2. Perioperative antibiotic prophylaxis
  3. Wound infections
  4. Cefazolin can replace penicillin in a penicillin allergy.

    Patients with penicillin allergy own a low risk of cross-allergy (10%), which is even lower with cephalosporines of the second and third generation.

Pharmacokinetics of Cefazolin

Cefazolin is only for parenteral istration available. Elimination half life 1.5 h, 90% renal elimination.

Contraindications of Cefazolin

Cephalosporin allergy.

Dosage of Cefazolin

In adults, the dosage of cefazolin is 1 g 1-1-1 i.v. Children get a daily dose of 60mg/kg body weight, divided in three doses.

What is cephalosporins allergy

Dose reduction is necessary in renal insufficiency.


Oral Cephalosporins

Ceftibuten

Ceftibuten is an oral cephalosporin which a high activity against Enterobacteriaceae and is suitable for the treatment of severe or complicated urinary tract infection in children Ho et al, 2001Vilaichone et al, 2001.

Pharmacokinetics of Ceftibuten:

Elimination half life 2.5 h. 70% renal elimination.

Pharmacokinetics of Cefixime:

Elimination half life 2.5 h, only 20% renal elimination, high biliary excretion.

Dosage of Ceftibuten:

400mg 1-0-0 in adults, 9mg/kg body weight 1-0-0 in children.

Cefpodoxime

Cefpodoxime is a derivative of ceftizoxime.

Cefpodoxime is suitable for the oral treatment of urinary tract infections.

Pharmacokinetics of cefpodoxime:

Elimination half life 2.5 h, 30–40% renal elimination.

Dosage of cefpodoxime:

Adults 200mg 1-0-1 and children 4mg/kg body weight 1-0-1.

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Cefixime

Cefixime is a derivative of cefotaxime, which can be given orally. Cefixime is suitable for the treatment of urinary tract infection in children Gok et al, 2001Ho et al, 2001.

Dosage of Cefixime:

Adults 200mg 1-0-1 or 400mg 1-0-0 p.o., children 4mg/kg body weight 1-0-1 or 8mg/kg 1-0-0.

What is cephalosporins allergy

References

Gok u.a. 2001 GOK, F.; DUZOVA, A.; BASKIN, E.; OZEN, S.; BESBAS, N.; BAKKALOGLU, A.:
Comparative study of cefixime alone versus intramuscular ceftizoxime followed by cefixime in the treatment of urinary tract infections in children.
In: J Chemother
13 (2001), Nr.3, S.277–80

Ho u.a. 2001 HO, M.W.; WANG, F.D.; FUNG, C.P.; LIU, C.Y.:
Comparative study of ceftibuten and cefixime in the treatment of complicated urinary tract infections.

In: J Microbiol Immunol Infect
34 (2001), Nr.3, S.185–9

Ovalle u.a. 2000 OVALLE, A.; MARTINEZ, M.A.; WOLFF, M.; CONA, E.; VALDERRAMA, O.; VILLABLANCA, E.; LOBOS, L.:
[Prospective, randomized, comparative study of the efficacy, safety and cost of cefuroxime versus cephradine in acute pyelonephritis during pregnancy].

What is cephalosporins allergy

In: Rev Med Chil
128 (2000), Nr.7, S.749–57

Simon und Stille 1997 SIMON, C.; STILLE, W.:
Antibiotika-Therapie in Klinik und Praxis.
9. Auflage.
Stuttgart New York: Schattauer, 1997

Vilaichone u.a.

What is cephalosporins allergy

2001 VILAICHONE, A.; WATANA, D.; CHAIWATANARAT, T.:

Oral ceftibuten switch therapy for acute pyelonephritis in children.
In: J Med Assoc Thai
84 Suppl 1 (2001), S.S61–7

Deutsche Version: Cephalosporine

Antibiotic Therapy for Musculoskeletal Infections


Third Generation of Cephalosporins

Important substances of third-generation cephalosporins are cefotaxime and ceftriaxone (cefotaxime-group).

Antibacterial Spectrum of cefotaxime and ceftriaxone

Cefotaxime and Ceftriaxone show excellent activity against streptococci, gonococci, meningococci, Haemophilus and staphylococci.

High β-lactamase resistance. Feeble activity against Pseudomonas. No activity against enterococci, mycoplasma, chlamydia and multidrug-resistant Staphylococcus aureus.

Side Effects of Cefotaxime and Ceftriaxone

  1. Allergy: 1–4%. There is a minimal risk for cross-allergy to penicillin.
  2. Inhibition of the efficacy of anticoagulants or antiplatelet agents
  3. Allergic neutropenia
  4. Positive direct Coombs test, extremely rarely hemolytic anemia.
  5. Alcohol intolerance possible

Urologic Indications for Third Generation Cephalosporins

  1. Severe urinary tract infections, can be combined with gentamicin to include enterococci
  2. Severe postoperative infections love peritonitis
  3. Treatment of gonorrhea with a single dose of ceftriaxone i.m.

Pharmacokinetics of Cefotaxime and Ceftriaxone

Only parenteral istration of cefotaxime and ceftriaxone is possible.

The elimination half life is 1h for cefotaxime and 7–8h for ceftriaxone. 50% renal elimination.

Contraindications

Cephalosporin allergy.

Dosage of Cefotaxime and Ceftriaxone

Treatment of severe infection: the daily dosage of cefotaxime in adults amounts to 3–6 g (children 50–100mg/kg), depending on the severity of the infection, and is divided into three doses.

What is cephalosporins allergy

The daily dosage for ceftriaxone is 2–4 g in two doses. Dose reduction is necessary with a renal insufficiency under a glomerular filtration rate of 5 ml/min.

Single shot treatment of gonorrhea: 250mg ceftriaxone i.m. [see Chapter gonorrhea].


Four Generation of Cephalosporins

Cephalosporins are β-lactam antibiotics, which are grouped into four generations according to their antibiotic spectrum of activity. The first generation has mainly gram-positive activity. The second and third generation has more gram-negative activity with mostly decreased activity against gram-positive bacteria.

The fourth generation of cephalosporins has a wide spectrum activity. The following list provides an overview over the generations of cephalosporins with major substances:

  1. First Generation: cefazolin, cefalexin, cefadroxil
  2. Third generation: cefotaxime, cefpodoxime, ceftizoxime, ceftriaxone, ceftazidime, cefoperazone
  3. Second Generation: cefamandole, cefoxitin, cefaclor, cefuroxime, loracarbef, cefotetan
  4. Fourth generation: cefepime, cefozopran, cefpirome, cefquinome


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What is cephalosporins allergy