Cephalosporin အသံုးမ်ားပိုးသတ္ေဆး

1st gen:  cephalosporin 

 Spectrum(staph,strep(not enterococcus),E.coli,proteus,Kleb:)

-Parental route(cefazolin,cephalothin)

-Oral route(cephalaxin,cefadroxil,cephradine)

2nd gen: cephalosporin 

Spectrum(1st gen: spectrum+H.influ(including beta-lactamase)

-Parental route(cefuroxime ,cefamanole)

-Oral route(cefaclor,cefuroxime,cefprozil)

2nd gen: cephalosporin 

Spectrum(above mention+bacteroides)

-Parental route(cefoxitin)

3rd gen: cephalosporin 

Spectrum(2nd gen: spectrum+most G(-) bacilli except pseudo)

-Parentral route(cefotaxime,ceftriazone)

-Oral route(cefpodoxime,Cefixime,ceftibuten)

3rd&4th gen: cephalosporin 

Spectrum(above+pseudo)

-Parentral route(ceftazidime,cefepime,cefpirome)

-all are active most strep. Except enterococcus 

-but they have no activity for listeria or methicillin resistance staph.

-3rd gen: have lower activity for staph than 1st&2nd

-It should be avoided if definite h/o of pen. Allergy

1st gen:

>alternative for staph. and strep.

>skin &soft tissue as well as strep. Pharyngitis

>not indicated empirical treatment of otitis media or sinusitis

>limited used in UTI(due to active in some E.coli,Kleb&proteus)

2nd gen:

>G(-) bacteria(H.influ,N.meningitis,M.catarrhalis)

>useful in URTI& LRTI ,sinusitis,otitis media)

>suitable for UTI

>cefoxitin is prophylaxis against GI surgery

3rd gen:

>most enteric G(-),salmonella ,shigella

>excellent against strep. Pneumonia

>active against N.gonorrhoea

>should only be used 1st choice drug failed

Oral 3rd gen:

>against N.gonorrhoea but not staph

>no activity in enterococcus ,pseudo,campylobacter

(ဘယ္ oral ceph မွ pen resistance pneumococcusမွာ Amoxilထက္ မေကာင္း)

>no advantage in sinusitis,otitis media,tonsillitis than amoxicillin

4th gen:

>cefipime (more for pseudomonas )

>cefpirome(more for pneumococcus)

Cabapenem

>imipenem/cilastatin

(imipenem is one of broadest A/B available)

-combine with cilastatin in renal tubular dehydropeptidase

-it lack against methicillin resistance staph,clostridium

-treatment of life threatening infection by highly resistance

>meropenem

-not required combination

-little effect of G(+) than imipenem

-alternative of ceftriazone or cefotaxime

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