How Do Other Cephalosporins Work?

Cephalosporins are broad-spectrum antibiotics used in the treatment of a wide range of bacterial infections. Cephalosporins are grouped into five generations based on their effectiveness against various types of gram-positive and gram-negative bacteria. Other cephalosporins include the fourth and fifth, the latest generations of cephalosporins.

First-generation cephalosporins are effective primarily against gram-positive bacteria but later generations of cephalosporins are effective against gram-negative bacteria also. Gram-negative bacteria are structurally different from gram-positive bacteria, and the types are identified by whether the bacteria get dyed or not in the Gram stain lab test.

Cephalosporins kill bacteria by inhibiting the synthesis of peptidoglycan, a vital constituent that provides stability to the bacterial cell wall. Cephalosporins are beta-lactam antibiotics that contain a beta-lactam ring in their chemical structure. Beta-lactam is a compound that targets and blocks penicillin-binding proteins, enzymes that are essential for the biosynthesis of peptidoglycan.

Some bacteria develop resistance to beta-lactam antibiotics by producing beta-lactamases, enzymes that cleave the beta-lactam rings in the antibiotics and destroy them. Some of the newer generation cephalosporins have enhanced stability against beta-lactamases and some are combined with beta-lactamase inhibitors.

The fourth and fifth-generation cephalosporins grouped under the “other” category are mainly used to treat serious and complicated infections of both gram-positive and gram-negative bacteria, including those with multi-drug resistance. Other cephalosporins include the following:

Cefepime: Cefepime is a fourth-generation cephalosporin, also described as anti-pseudomonal cephalosporin, effective against Pseudomonas aeruginosa and other gram-negative and gram-positive bacteria. 

Cefiderocol: Cefiderocol is a siderophore cephalosporin effective against multidrug-resistant gram-negative aerobic bacteria. Siderophore is a substance that microorganisms produce to absorb iron, an essential nutrient they require for cellular processes. The siderophore component of cefiderocol helps penetrate the bacterial wall and enter the cell.

Ceftaroline: Ceftaroline is a fifth-generation cephalosporin, also described as anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) cephalosporin, effective against resistant MRSA bacterial strains. Ceftaroline has activity against aerobic and anaerobic gram-positive and aerobic gram-negative bacteria.

Ceftolozane/tazobactam: Ceftolozane, a fifth-generation cephalosporin combined with tazobactam, a beta-lactamase inhibitor, is a potent antibiotic against multidrug resistant Pseudomonas aeruginosa and other gram-negative bacteria.

Other cephalosporins are primarily administered as intravenous (IV) infusions, and in some cases may be administered as intramuscular (IM) injections. Other cephalosporins are approved by the FDA for use in the treatment of conditions that include:

• Cefepime:
  • Moderate-to-severe pneumonia
  • Febrile neutropenia (low neutrophil count in the blood)
  • Uncomplicated and complicated urinary tract infections (UTIs) including pyelonephritis (kidney infection)
  • Uncomplicated skin and skin structure infections
  • Complicated intra-abdominal infections, in combination with metronidazole
• Cefiderocol:
  • Complicated urinary tract infections, including pyelonephritis, caused by susceptible gram-negative microorganisms
  • Hospital-acquired and ventilator-associated bacterial pneumonia caused by susceptible gram-negative microorganisms
• Ceftaroline:
  • Community-acquired bacterial pneumonia
  • Acute bacterial skin and skin structure infections, including methicillin-resistant Staphylococcus aureus (MRSA)
• Ceftolozane/tazobactam:
  • Complicated intra-abdominal infections, in combination with metronidazole
  • Complicated urinary tract infections, including pyelonephritis
  • Hospital-acquired and ventilator-associated bacterial pneumonia caused by susceptible gram-negative microorganisms

Side effects of other cephalosporins vary with each type of drug. A few of the most common side effects may include:

• Cefepime:
  • Positive Coombs test without hemolysis (Coombs test looks for antibodies to red blood cells, which can destroy red blood cells)
  • Rash and pruritus (itching)
  • Elevated liver enzyme alanine aminotransferase (ALT)
  • Hypophosphatemia (low phosphate level in blood)
  • Diarrhea, nausea, and vomiting
• Cefiderocol:
  • Elevated liver enzymes
  • Hypokalemia (low potassium level in the blood)
  • Infusion site reactions and rash
  • Diarrhea or constipation
  • Candidiasis (Candida yeast infection)
• Ceftaroline:
  • Diarrhea or constipation
  • Nausea and vomiting
  • Rash and pruritus
  • Increase in liver enzymes
  • Phlebitis (inflammation of a vein)
• Ceftolozane/tazobactam:
  • Elevated liver enzymes
  • Nausea and vomiting
  • Headache and fever
  • Diarrhea or constipation
  • Insomnia

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of some of the other cephalosporins include:

• cefepime
• cefiderocol
• ceftaroline
• ceftolozane/tazobactam
• Fetroja
• Maxipime
• Teflaro
• Zerbaxa