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Cephalosporins

By

Brian J. Werth

, PharmD, University of Washington School of Pharmacy

Last full review/revision Jul 2020| Content last modified Jul 2020
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NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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Cephalosporins are a subclass of antibiotics called beta-lactam antibiotics (antibiotics that have a chemical structure called a beta-lactam ring). Beta-lactam antibiotics also include carbapenems, monobactams, and penicillins.

There are five main classifications or generations of cephalosporins. The different generations are effective against different types of bacteria.

Most bacteria have an outer covering (cell wall) that protects them. Like the other beta-lactam antibiotics, cephalosporins work by preventing bacteria from forming this cell wall, resulting in death of the bacteria.

Because cephalosporins are structurally similar to the penicillins, some people who have an allergic reaction to penicillins may have an allergic reaction to certain cephalosporins. A health care practitioner can help assess the risk of allergic cross-reactivity between specific antibiotics in people who believe they have had an allergic reaction.

Table
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Cephalosporins

Drug

Common Uses

Some Side Effects

1st generation

Cefadroxil

Cefazolin

Cephalexin

Given before surgical procedures to prevent infections

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

2nd generation

Cefaclor

Cefotetan

Cefoxitin

Cefprozil

Cefuroxime

Some respiratory infections

For cefoxitin: Abdominal infections

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

3rd generation

Cefdinir

Cefditoren

Cefixime

Cefotaxime

Cefpodoxime

Ceftazidime

Ceftibuten

Ceftriaxone

Given by mouth: Broad coverage of many bacteria for people with mild-to-moderate infections, including skin and soft-tissue infections

Given by injection: Serious infections (such as meningitis or infections acquired in a hospital)

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

4th generation

Cefepime

Serious infections (including Pseudomonas infections), particularly in people with a weakened immune system, and infections due to susceptible bacteria that are resistant to other antibiotics

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

5th generation

Ceftaroline

Infections due to susceptible bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

Ceftobiprole

Infections due to susceptible bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

Novel cephalosporins

Cefiderocol

Urinary tract infections due to susceptible bacteria, such as Escherichia coliKlebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Enterobacter, in people over 18 years of age who have limited or no alternative treatment options

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

Ceftolozane plus tazobactam

Complicated urinary tract or abdominal infections, or hospital-acquired pneumonia or ventilator-associated pneumonia due to sensitive organisms

Gastrointestinal upset and diarrhea*

Nausea

Allergic reactions (more likely in people allergic to penicillin)

Kidney and liver problems

* Almost any antibiotic can cause Clostridioides difficile–induced diarrhea and inflammation of the colon (colitis), but clindamycin, penicillins, cephalosporins, and fluoroquinolones are the most common causes.

Ceftobiprole is not available in the United States.

Use of Cephalosporins During Pregnancy and Breastfeeding

Cephalosporins are among the safest antibiotics to use during pregnancy but are not without risks. Each drug is slightly different and may have different side effects. (See also Drug Use During Pregnancy.)

Use of cephalosporins during breastfeeding is discouraged because these drugs may affect the baby's digestive tract. (See also Drug Use During Breastfeeding.)

Drugs Mentioned In This Article

Generic Name Select Brand Names
Ceftobiprole
ROCEPHIN
No US brand name
FORTAZ, TAZICEF
CLEOCIN
KEFLEX
CLAFORAN
SPECTRACEF
CEFTIN, ZINACEF
CEDAX
MEFOXIN
ANCEF, KEFZOL
SUPRAX
MAXIPIME
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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