| 1st | 2nd | 3rd | 4th | 5th | |
| Common Drugs | Cephalexin (Keflex) – po Cefadroxil (Duricef) – po Cefazolin – IV, IM |
Cefuroxime – po, IV Cefotetan Cefoxitin |
Ceftriaxone Cefotaxime Ceftazidime – covers pseudo Cefdinir – po Cefixime – po |
Cefepime – covers pseudo | Ceftaroline – covers MRSA Ceftolozane/tazobactam |
| Anaerobic Coverage | No | Yes (Cefoxitin, Cefotetan, Cefmetazole) | No | No (poor anaerobic coverage) | Yes – Ceftolozane/tazobactam |
| Pseudomonas Coverage | No | No | Yes -Ceftazidime | Yes – Cefepime | Yes – Ceftolozane/tazobactam |
| Gram + coverage | Strep, staph | Same as 1st Gen | Decr. Staph coverage. | STRONG gm+ coverage | |
| Gram – Coverage | E. Coli, Proteus, Klepsiella | Better GN than 1st Gen | Better gm- coverage. Now covers N. gonorrhea, Enterobacter, Serratia | STRONG gm- coverage | |
| MRSA | No | No | No | No | Yes – Ceftaroline |
| Common Uses | Excellent Gram Pos Coverage. Excellent for skin infections (cellulitis) Surgeons love to give 1st Gen before surgery to prevent skin infections. |
Covers more GM Negs than 1st Gen. Anaerobic coverage (cefoxitin, Cefotetan, Cefmetazole) Intra-abdominal Infections |
Lung Infections (CAP), Meningitis, Pyelonephritis (UTI that has progressed to involved the kidneys) Ceftriaxone and Cefotaxime both have excellent CSF penetration and cover the common bacteria that frequently cause meningitis. Ceftazidime covers Pseudomonas |
Serious infections – FUO HCAP Neutropenic fever Pseudomonas Infections |
MRSA Skin & soft tissues infections PNA |
**Ceftriaxone is the drug of choice in adults with meningitis while cefotaxime is the first-line drug in neonates and children with meningitis. Why? Because ceftriaxone may interfere with bilirubin metabolism in neonates, which is why we choose ceftazidime for them.
| Gram Negatives | Streptococcus Pneumoniae and other streptococci | Gram Positives (Staph aureus) |
|
| 1st Gen | + | +++ | +++ |
| 2nd Gen | ++ | ++ | ++ |
| 3rd Gen | +++ | +++ | + |
https://www.uptodate.com/contents/cephalosporins