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Antibiotics - Cephalosporins: Nursing pharmacology

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ANTIBIOTICS: CEPHALOSPORINS, PART 1
DRUG NAME
cefazolin 
(Ancef, Kefzol); cefadroxil (Duricef); cephalexin (Keflex)
cefaclor (Ceclor); cefotetan (Cefotan); cefoxitin (Mefoxin); cefprozil (Cefzil); cefuroxime (Ceftin, Kefurox, Zinacef)
cefixime (Suprax); cefotaxime (Claforan); ceftazidime 
(Fortaz, Tazicef); 
ceftriaxone
CLASS
Cephalosporins
GENERATION
First generation
Second generation
Third generation
MECHANISM OF ACTION
Disrupt the synthesis peptidoglycan layer → weakening of bacterial cell wall → bacterial cell death
MICROBIAL COVERAGE
  • Gram positive bacteria
  • Gram negative bacteria
  • Gram negative bacteria  
    • H. influenzae 
    • Bacteroides spp
  • Enterobacteriaceae
  • other Gram negative bacteria
  • Gram positive bacteria
INDICATIONS
  • Bacterial infections of the respiratory tract, urinary tract, and skin
  • Osteomyelitis
  • Septic arthritis
  • Surgical antibiotic prophylaxis
  • Osteomyelitis
  • Septic arthritis
  • Meningitis
  • Meningitis
  • Septicemia
  • Pelvic inflammatory disease
  • Skin and soft tissue infections
  • Otitis media
ROUTE(S) OF ADMIN.
PO; IM; IV
SIDE EFFECTS
  • Headaches, dizziness, seizures
  • Nausea, vomiting, diarrhea, Clostridioides difficile infection (CDI)
  • Skin rash, injection site reactions, hypersensitivity reactions (e.g., Stevens-Johnson syndrome, anaphylaxis)
  • Renal failure
  • Electrolyte abnormalities (e.g., hyperkalemia)
  • Anemia, neutropenia, thrombocytopenia
CONTRA-INDICATIONS & CAUTIONS
  • Allergies to beta-lactam antibiotics
  • Infants younger than one month
  • Pregnancy and breastfeeding
  • Elderly clients
  • Anemia, coagulation disorders
  • Gastrointestinal diseases
  • Renal disease, dialysis
ANTIBIOTICS: CEPHALOSPORINS, PART 2
DRUG NAME
cefepime (Maxipime)
ceftaroline
CLASS
Cephalosporins
GENERATION
Fourth generation
Fifth generation
MECHANISM OF ACTION
Disrupt the synthesis peptidoglycan layer → weakening of bacterial cell wall → bacterial cell death
MICROBIAL COVERAGE
  • Gram positive bacteria
  • more effective against Gram negative bacteria
  • Gram positive bacteria
INDICATIONS
  • Bacterial infections of the respiratory tract, urinary tract, skin, intra-abdominal infections
  • Community-acquired pneumonia
  • Skin infections
ROUTE(S) OF ADMINISTRATION
IV; IMIV
SIDE EFFECTS
  • Headaches, dizziness, seizures
  • Nausea, vomiting, diarrhea, Clostridioides difficile infection (CDI)
  • Skin rash, injection site reactions, hypersensitivity reactions (e.g., Stevens-Johnson syndrome, anaphylaxis)
  • Renal failure
  • Electrolyte abnormalities (e.g., hyperkalemia)
  • Anemia, neutropenia, thrombocytopenia
CONTRAINDICATIONS & CAUTIONS
  • Allergies to beta-lactam antibiotics
  • Infants younger than one month
  • Pregnancy and breastfeeding
  • Elderly clients
  • Anemia, coagulation disorders
  • Gastrointestinal diseases
  • Renal disease, dialysis
NURSING CONSIDERATIONS for ANTIBIOTICS: CEPHALOSPORINS
ASSESSMENT AND MONITORING
Assessment
  • Weight
  • Vital signs
  • Fluid intake and output
  • Laboratory test results: CBC, renal and hepatic function, electrolytes

Monitoring / interventions
  • Ensure adequate hydration
  • Patient IV
  • Indwelling urinary catheter
  • Confirm ordered dose
  • Monitor
    • Insertion site for extravasation
    • Hypersensitivity reaction
    • Vital signs
    • Urine output
  • Evaluate therapeutic response: absence of postoperative surgical site; approximated wound edges, infection, stable vital signs
CLIENT EDUCATION
  • Purpose of medication: to prevent surgical site infection
  • Side effects: alterations in blood count, fluid and electrolyte balance; effects on the liver and gastrointestinal system

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Content Reviewers

Ashley Mauldin MSN, APRN, FNP-BC,Antonella Melani, MD,Lisa Miklush, PhD, RNC, CNS,Jannah Amiel, MS, BSN, RN,Gabrielle Proper, RN, BScN, MN

Cephalosporins are a large group of broad-spectrum antibiotics, which can be used to treat a wide variety of bacterial infections, including meningitis, pneumonia, urinary tract infections, and sepsis. These antibiotics get their name from Cephalosporium acremonium, a fungus from which they are derived.

Now, cephalosporins belong to beta-lactam antibiotics, which means they have a beta-lactam ring in their core, and they mainly work by disrupting the synthesis of the peptidoglycan layer, a major component of bacterial cell walls. This weakens the bacterial cell wall, ultimately killing the bacteria.

Now, cephalosporins are typically classified into five generations, each being used to treat certain types of bacterial infections.

First-generation cephalosporins include cephalexin, which is administered orally; cefadroxil, which is administered orally and intravenously; and cefazolin, which is given intravenously and intramuscularly.

In general, first-generation cephalosporins are effective against most gram-positive bacteria, such as Staphylococci and Streptococci species; as well as some gram-negative bacteria like Escherichia coli, Proteus mirabilis, and Klebsiella pneumonia.

So, first-generation cephalosporins are used to treat respiratory tract infections, urinary tract infections, some skin infections; and bone and joint infections. They can also be given as surgical antibiotic prophylaxis, to prevent infections from spreading to deeper tissues during surgical operations.

Next, second-generation cephalosporins include cefaclor and cefprozil which are administered orally; as well as cefotetan and cefoxitin, which are given intravenously and intramuscularly; and cefuroxime, which is given orally and intravenously.

Compared to the first generation, second-generation cephalosporins are less effective against Staphylococcus species. Instead, they are more effective against certain types of gram-negative bacteria, such as Haemophilus influenzae, which can cause infections like otitis media, respiratory tract infections, or septicemia; as well as Bacteroides, which can causes infections like osteomyelitis, septic arthritis, and meningitis.