Third generation cephalosporins

What are Third generation cephalosporins?

After the first cephalosporin was discovered in 1945, scientists improved the structure of cephalosporins to make them more effective against a wider range of bacteria. Each time the structure changed, a new "generation" of cephalosporins were made. There are five generations of cephalosporins. Third generation cephalosporins were the third generation of cephalosporins to be developed.

Cephalosporins are a large group of antibiotics derived from the mold Acremonium (previously called Cephalosporium). Cephalosporins are bactericidal (kill bacteria) and work in a similar way to penicillins. They bind to and block the activity of enzymes responsible for making peptidoglycan, an important component of the bacterial cell wall. They are called broad-spectrum antibiotics because they are effective against a wide range of bacteria.

What are third-generation cephalosporins used for?

Third generation cephalosporins may be used to treat the following types of infections when caused by susceptible strains of bacteria:

Bacteremia/septicemia
Bone and joint infections
Central nervous system infections
Gynecological infections
Intra-abdominal infections
Lower respiratory tract infections
Skin and skin structure infections
Urinary tract infections.

What are the differences between third-generation cephalosporins?

There are differences between third-generation cephalosporins with regards to the bacteria they are effective against. No single third-generation cephalosporin treats all infectious disease scenarios.

Cefotaxime and ceftizoxime (discontinued) offer the best gram-positive coverage out of all the third-generation agents; ceftazidime and cefoperazone (discontinued) are unique in that they provide antipseudomonal coverage.

Ceftriaxone has a long half-life which allows for once daily dosing and may be used for the treatment of gonorrhea, pelvic inflammatory disease, and epididymo-orchitis. It is also an alternative to penicillins for suspected meningitis.

All the third-generation cephalosporins except for cefoperazone (discontinued) penetrate cerebrospinal fluid.

Generic name	Brand name examples
cefdinir	Generic only
cefditoren	Discontinued
cefixime	Suprax
cefoperazone	Discontinued
cefotaxime	Claforan
cefpodoxime	Generic
ceftazidime	Fortaz, Tazicef
ceftibuten	Discontinued
ceftriaxone	Generic only

Are third generation cephalosporins safe?

Third generation cephalosporins are generally safe, with low toxicity and good efficacy against susceptible bacteria.

Allergic reactions have been reported with all cephalosporins including third generation cephalosporins and symptoms may include a rash, hives (urticaria), swelling, or rarely, anaphylaxis. Up to 10% of people with a history of penicillin allergy will also be allergic to cephalosporins.

Drug-induced hemolytic anemia has been associated with use of some cephalosporins, including third generation cephalosporins; suspect and investigate further if anemia develops during or after treatment.

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.

Rarely, seizures have been reported with cephalosporins; the risk may be greatest in those with kidney disease.

Cephalosporin should be given exactly as directed. Potentially life-threatening arrhythmias have been reported following rapid bolus administration of cefotaxime, a third generation cephalosporin.

For a complete list of severe side effects, please refer to the individual drug monographs.

What are the side effects of third generation cephalosporins?

Third generation cephalosporins generally cause few side effects. The most common side effects reported include:

Abdominal pain
Diarrhea
Injection site inflammation
Itchy skin
Nausea
Rash
Vomiting.

Transient increases in liver enzymes have also been reported.

For a complete list of side effects, please refer to the individual drug monographs.

List drug with Third generation cephalosporins

Drug Name
Cedax Generic name: Ceftibuten
Cefdinir Generic name: Cefdinir
Cefditoren Generic name: Cefditoren
Cefditoren pivoxil Generic name: Cefditoren Pivoxil
Cefixime Generic name: Cefixime
Cefoperazone Generic name: Cefoperazone
Cefotaxime Generic name: Cefotaxime
Cefpodoxime Generic name: Cefpodoxime
Ceftazidime Generic name: Ceftazidime
Ceftazidime injection Generic name: Ceftazidime (injection)
Ceftibuten Generic name: Ceftibuten
Ceftriaxone Generic name: Ceftriaxone
Ceftriaxone injection Generic name: Ceftriaxone (injection)
Claforan Generic name: Cefotaxime
Fortaz Generic name: Ceftazidime (injection)
Omnicef Generic name: Cefdinir
Omnicef Omni-Pac Generic name: Cefdinir
Rocephin Generic name: Ceftriaxone (injection)
Spectracef Generic name: Cefditoren
Suprax Generic name: Cefixime
Tazicef Generic name: Ceftazidime (injection)
Tazicef ADD-Vantage Generic name: Ceftazidime (injection)
Vantin Generic name: Cefpodoxime

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