Cefotetan or Cefotan is another product very similar to cefoxitin in its uses. It is used less often, once a day or twice a day, so this may be preferable in some circles if you want to use a cephalosporin for anaerobes.
Cefmetazole can cause some reactions. Bleeding, disulfiram or Antabuse-like reactions with alcohol. We really don’t see a unique use for this product so we tend not to talk very much about it.
Similarly, cefonicid is marketed as Monocid. It has more activity against H. flu but it is less active against Gram positives. So, again, we don’t see a really unique place where this drug should be used and it’s one that I don’t see a particular amount of use for.
Now, if I need to stick a stick in a hornet’s nest and shake it up, this is the one drug that I will potentially create controversy with and that’s cefaclor or Ceclor. This drug is way overused. It is a very palatable drug. Children will take it. But it is not that effective. It has been shown that tissue levels may be lower than with other oral cephalosporins. Serum sickness is possible with repeat use, much more so than with any of the other cephalosporins and actually the cost of this drug, even though it is now available in generic form, is only about $5 for a prescription less than some of the new second and third generation cephalosporins. So this really is a drug that possibly you could forget about and there are plenty of other good drugs available that are going to cause a lot fewer calls in the middle of the night because of treatment failures or adverse reactions.
Cefprozil is Cefzil. This is a product that is given once or twice a day as an oral tablet or suspension. It can be used for otitis media and soft tissue infections although this is not a drug of first choice usually. It certainly is a reasonable alternative particularly in patients who have trouble tolerating some of the drugs that we will mention to you later.
Cefuroxime is marketed as a parenteral product – Zinacef – and also as an oral tablet or suspension as Ceftin. While it used to be used in meningitis, it is no longer recommended for use because it is not as effective as the third generation agents. It does have good activity against many of the common infecting organisms that cause soft tissue infections and pneumonias. It is a good empiric therapy, for example, in a pediatric pneumonia because it covers most of the common infecting organisms unless you think there is a meningitis present.
The problem with cefuroxime is that it is very bitter. The suspension needs to be given with food. Regardless, it tastes bad. Kids under three don’t seem to mind that terribly and that’s a prime age group for using this drug, for example, in acute otitis media and I will mention another drug that is very similar to this in a few minutes. But it is less expensive than the third generation cephalosporins so it may have some cost advantage unless you’re worried about meningitis.
Third generation cephalosporins generally have an increased Gram negative spectrum with decreased Gram positive activity generally. They are considered third generation based on a broader Gram negative spectrum. Some people think of these as being third generation because of anti-Pseudomonal activity but frankly none of the oral third or fourth generation agents have Pseudomonas coverage.
CSF levels with many of these parenteral products are adequate to treat meningitis. In fact, several of these drugs are considered drugs of choice for meningitis now. Be aware though that these drugs have poor coverage of Listeria and poor coverage of Enterococcus so you can get overgrowth of these particular organisms. For example, in a neonatal intensive care unit you may see ampicillin being added to Claforan in a child with sepsis to cover the possibility of Listeria.
Cefotaxime is Claforan. This is probably the most useful of the third generation cephalosporin parenteral products. It is given parenterally usually every six hours. It is a drug of choice for neonatal sepsis and meningitis and is a drug for meningitis in general in pediatrics. It is useful in gonorrhea especially in young children and in CNS Lyme disease. It has minimal effects on bowel flora and that fact is going to come back as we talk about several of the other products in terms of being a unique advantage for this product.
Ceftizoxime is Ceftizox. This particular product is like Claforan or cefotaxime but it is given every eight hours. However, we don’t have a great deal of experience with this in children and the literature generally has not adapted this instead of cefotaxime. Cefotaxime continues to be the preferred drug.
Ceftriaxone is Rocephin. This particular product is just as good as Claforan against meningitis. The advantage here is that it is given once a day. The problem here, though, is that this drug has a much greater effect on suppressing bowel flora than does cefotaxime. It’s for that reason that we would prefer to use cefotaxime or Claforan for IV therapy in institutionalized patients and switch to Rocephin or ceftriaxone when we switch to IM therapy or for home therapy. There is no sense in inducing pseudomembranous colitis or other severe diarrheas with a drug when we have an alternative drug that is only a little more expensive that is available and that is the reasoning behind the use of that. However, that said, this is a very good drug for treating gonorrhea. It’s a good drug for treating serious Lyme disease and it is especially useful for IM therapy.
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