Cephalosporins are the antibiotics prescribed to treat a wide variety of bacterial infections (eg; Respiratory tract infections, urinary tract infections, and skin infections). Cephalosporins are bactericidal agents, meaning they kill bacteria directly. They directly act on the bacterial cell wall.

Cephalosporins are classified into 5 generations, each generation is effective against certain types of bacteria. The 1st-generation drugs are effective mainly against gram-positive organisms. Higher generations generally have expanded spectra against aerobic gram-negative bacilli.

Cephalosporins belong to the similar spectrum of antibiotics as of penicillins and might cause an allergic reaction in people who are allergic to penicillins. Based on the severity of penicillin allergy, you can still be able to consume cephalosporins, but most likely not first- or second-generation drugs.

Examples of cephalosporins include

  • Ancef and Kefazol (cefazolin)
  • Ceclor and Cefaclor (cefaclor)
  • Cefdinir
  • Ceftin and Zinacef (cefuroxime)
  • Duricef (cefadroxil)
  • Keflex and Keftabs (cephalexin)
  • Maxipime (cefepime)
  • Rocephin (ceftriaxone)
  • Suprax (cefixime)
  • Teflaro (ceftaroline fosamil)

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How do Cephalosporins work?

Cephalosporins work by inhibiting the bacterial cell wall synthesis and hence it destroys the bacteria. They inhibit the cell wall synthesis of dividing bacteria and their action is irreversible.

Forms and Dosage

These antibiotics are available in tablet and injection form.

Oral form is used for skin and soft tissue infections while injection form is used for severe infections like Bacterial Endocarditis.

Cephalosporins include wide ranges of dosage strengths for adults and pediatric patients,

Usually 250-500mg, 300-600mg, 200-400mg  twice daily are the ranges prescribed for adults depending on the infection being treated.

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Cephalosporins – Indications

Cephalosporins are used for the treatment, control, prevention, & improvement of the following diseases, conditions and symptoms:

  • Meningitis
  • Gynaecological infections
  • Urinary tract infections
  • Respiratory tract infections
  • Bone and joint infections
  • Skin and soft tissue infections
  • Septicemia
  • Intra-abdominal infections
  • Peritonitis
  • Endometritis
  • Surgical infections
  • Pelvic inflammatory disease

Cephalosporins penetrate well into most body fluids and the ECF of most tissues, especially when inflammation (which enhances diffusion) is present. However, the only cephalosporins that reach CSF levels high enough to treat meningitis are

  • Ceftriaxone, Cefotaxime, Ceftazidime, Cefepim.

Contra Indications of Cephalosporins

  • Cephalosporins are contraindicated in patients who are allergic to them or who have had an anaphylactic reaction to penicillins.
  • Third Generation cephalosporin-Ceftriaxoneis contraindicated as follows:

Ceftriaxone IV must not be coadministered with calcium-containing IV solutions (including continuous calcium-containing infusions such as parenteral nutrition) in neonates ≤ 28 days because precipitation of ceftriaxone-calcium salt is a risk. Fatal reactions with ceftriaxone-calcium precipitates in the lungs and kidneys of neonates have been reported.

Because an interaction between ceftriaxone and IV calcium-containing solutions is theoretically possible in patients other than neonates, ceftriaxone and calcium-containing solutions should not be mixed or given within 48 h of each other.

  • No data on potential interaction between ceftriaxone and oral calcium-containing products or on interaction between IM ceftriaxone and calcium-containing products (IV or oral) are available.
  • Ceftriaxone should not be given to hyperbilirubinemic and preterm neonates because in vitro, ceftriaxone can displace bilirubin from serum albumin, potentially triggering kernicterus (Infant Jaundice).

 Side effects

As all drugs, Cephalosporins also causes adverse effects that are mentioned below. These side effects of Cephalosporins are possible, but do not always occur. Some of the side effects may be rare but serious. Consult your physician if you notice any of the following side effects, especially if they do not go away.

The following are the most common side effects of Cephalosporins:

  • Rashes
  • Fever
  • nausea, and vomiting
  • Haematological-Decreased Hemoglobin concentration(Hematocrit value)
  • skin reactions
  • Diarrhoea or loose stools
  • Eosinophilia
  • Urticaria, and pruritus
  • High levels of SGOT, SGPT in the blood serum, and alkaline phosphatase concentrations
  • Increased BUN levels(blood, urea, nitrogen) and serum creatinine concentrations
  • GIT problems.
  • Rarely, some people may develop a super-infection due to overgrowth of a naturally occurring bacterium called Clostridium difficile, following use of any antibiotic, including cephalosporins. Symptoms may include severe diarrhea.
  • Seizures have been reported in some cases.

Precautions while taking Cephalosporins

  • Never take antibiotic medicines for a viral infection like a cold or the flu.
  • Complete course of treatment must be taken, as directed by your physician even if you feel better.
  • Give details about your pregnancy or planning for it or breastfeeding.
  • Notify your doctor about past history of kidney disease, epilepsy or heart diseases.
  • Before taking Cephalosporins, tell your physician if you are allergic to it; or if you have any other allergies. This medicine contains inactive ingredients, which can cause allergic reactions or other problems. Consult your physician for more information.
  • Before using this Cephalosporins, tell your physician your medical history, especially if u have severe kidney problems, have a history of tendon problems (eg, rheumatoid arthritis), or have received an organ (example; kidney, heart, or lung) transplant.
  • You should inform your physician about all the products you use any herbal products, prescription and non-prescription drugs.
  • During pregnancy,  Cephalosporins should be used only when clearly needed. Discuss the benefits and risks with your physician.
  • Breast feeding: Cephalosporins passes into breast milk discuss risks and benefits with your physician before breastfeeding.

Cephalosporins – Drug Interactions

When other drugs or over the counter products are taken at the same time along with this medicine, the effects of Cephalosporins may change, and can cause side effects or can make your drug not to work properly.  It is necessary to inform your doctor about all the drugs at present you are taking, Vitamins, etc. so that it is easier for your doctor to prevent or manage drug interactions.

The following are the drugs and products that may interact with Cephalosporins:

  • Alcohol
  • Acid reflux drugs like (Pepcid (famotidine), Tagamet (cimetidine), or Zantac (ranitidine) etc.
  • Other heartburn drugs like Aciphex (rabeprazole), Dexilant (dexlansoprazole), Nexium (esomeprazole)
  • Vivotif (live typhoid vaccine)

Intimate your doctor about taking a cephalosporin if you’re taking above mentioned drugs.

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