THE SELECTION AND USE OF CEPHALOSPORINS - A REVIEW

Cephalosporins are among the most frequently prescribed antibiotics as a result of their broad spectrum of microbiologic activity, favorable pharmacokinetics, low incidence of adverse reactions, and proven clin ical efficacy for a wide variety of infections. Cephalosporins differ in their gram-positive, gramnegative, and anaerobic spectra, serum hal f-lives, penetration of the cerebrospinal fluid, and resistance to bet a-lactamases. The first-generation and some second-generation agents m aintain excellent activity against streptococci and staphylococci, whi le the third-generation agents have expanded gram-negative coverage. T wo third-generation cephalosporins, ceftazidime and cefoperazone, are active against Pseudomonas. Ceftizoxime has become the workhorse third -generation cephalosporin. The fourth-generation agent cefepime provid es excellent activity against gram-positive and gram-negative pathogen s, including antibiotic-resistant Enterobacteriaceae. A major dilemma facing the practitioner is how to select the ''right'' cephalosporin f or a particular patient, as no one drug will satisfy all clinical need s. This review describes a practical approach to selecting an appropri ate cephalosporin for common infectious disease problems.