Fourth generation cephalosporin

  • Beta lactam antibiotic
  • Inhibits transpeptidation reaction of bacterial cell wall synthesis
  • Halts peptidoglycan synthesis, leading to inhibition of bacterial growth, and ultimately cell death (bacteriocidal)
  • Beta-lactam antibiotics kill bacterial cells only when they are actively growing and synthesising cell wall
  • Penetrates well into CSF
  • Half-life 2 hours
  • Renal clearance
Antimicrobial activity
  • More resistant to chromosomal B-lactamases (e.g. those produced by Enterobacter)
  • Good activity against P aeruginosa, Enterobacter, MSSA, S. pneumoniae
  • Highly active against Haemophilus and Neisseria sp.
  • Commonly used in empirical treatment of febrile neutropenia
Adverse effects of cephalosporins
  • Allergy:
    • Cross-allergenicity between penicillins and cephalosporins is ~1%
  • Toxicity:
    • Thrombophlebitis after IVI
    • Renal toxicity: interstitial nephritis, tubular necrosis (rare)
  • Methylthiotetrazole-containing agents (cefotetan, cefoperazone) may cause bleeding disorders and disulfiram-like reactions
  • Penicillin anaphylaxis
  • Dose reduction in renal failure
Further reading

Pharmacology 101

Top 200 drugs

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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