Cephalosporins

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  1. First generation – active against aerobic Gram positive cocci but not staph epi or MRSA (e.g. cefazolin)
  2. Second generation – stronger against Gram negative aerobic and anaerobic bacilli of enteric origin (e.g. cefoxitin)
  3. 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)
  4. Fourth generation – effective against Gram negatives including Pseudomonas aeruginosa and aerobic Gram positive cocci- streptococci and MSSA (e.g. cefepime)
  5. Ceftazidime and cefepime are on decline because of emerging resistance, ceftriaxone is still popular agent for community acquierd pneumonia and meningitis empirical coverage.
  6. Toxicity
    1. adverse reactions are uncommon and nonspecific (nausea, rash, diarrhea)
    2. there is a 5-15% incidence of cross antigenicity with penicillin and should be avoided in patients with prior anaphylactic reaction to penicillin

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