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- First generation – active against aerobic Gram positive cocci but not staph epi or MRSA (e.g. cefazolin)
- Second generation – stronger against Gram negative aerobic and anaerobic bacilli of enteric origin (e.g. cefoxitin)
- Third generation – effective against Gram negative aerobic bacilli including pseudomonas and H. flu but less active against aerobic Gram positive cocci (e.g. cefotaxime, ceftriaxone, and ceftazidime)
- Fourth generation – effective against Gram negatives including Pseudomonas aeruginosa and aerobic Gram positive cocci- streptococci and MSSA (e.g. cefepime)
- Ceftazidime and cefepime are on decline because of emerging resistance, ceftriaxone is still popular agent for community acquierd pneumonia and meningitis empirical coverage.
- adverse reactions are uncommon and nonspecific (nausea, rash, diarrhea)
- there is a 5-15% incidence of cross antigenicity with penicillin and should be avoided in patients with prior anaphylactic reaction to penicillin