Cephalosporins Flashcards
(15 cards)
Ceftiofur Sodium
A veterinary-only third-generation cephalosporin approved for use in dogs, horses, cattle, sheep/goats, swine, and poultry. Also used in an extra-label manner in a variety of other species
Ceftiofur is a time-dependent bactericidal antibiotic active against a variety of gram-positive and gram-negative bacteria; like other cephalosporins, it inhibits bacteria cell wall synthesis.
Ceftiofur is rapidly cleaved into furoic acid and desfuroylceftiofur (active). Desfuroylceftiofur inhibits cell wall synthesis (at stage 3) of susceptible multiplying bacteria and exhibits a spectrum of activity similar to that of cefotaxime (ie, a third-generation cephalosporin). Parent ceftiofur and the primary metabolite are equally potent and assays to measure microbial sensitivity (plasma and tissue levels) are based on ceftiofur equivalents (CE). Ceftiofur has a broad range of in vitro activity against a variety of pathogens, including Pasteurella spp, Streptococcus spp, Staphylococcus spp, Salmonella spp, and Escherichia coli. It is ineffective against methicillin-resistant staphylococci, extended spectrum β-lactamase producing gram-negative bacteria, and enterococci.
Potentially causes hypersensitivity reactions, granulocytopenia, thrombocytopenia, or diarrhea
Causes pain on IM injection in small animals
Cefotaxime
Third-generation cephalosporin for parenteral use
Inhibits bacteria cell wall synthesis. It is bactericidal and time-dependent. Cefotaxime has a relatively wide spectrum of activity against both gram-positive and gram-negative bacteria. While less active against Staphylococcus spp. than the first-generation agents, it still has significant activity against those and other gram-positive cocci, except Enterococcus spp. Cefotaxime, like the other third-generation agents, has extended coverage of gram-negative aerobes particularly in the Enterobacterales, including Klebsiella spp, E coli, and Salmonella spp. Many anaerobes are also susceptible to cefotaxime including strains of Bacteroides fragilis, Clostridium spp, Fusobacterium spp, Peptococcus spp, and Peptostreptococcus spp. Cefotaxime is as effective as penicillins for treating leptospirosis in humans. Like most other third-generation cephalosporins, cefotaxime is ineffective against Serratia spp, Proteus vulgaris, Acinetobacter spp, Citrobacter spp, and Enterobacter spp (“SPACE” organisms), as well as Pseudomonas aeruginosa, methicillin-resistant staphylococci, and extended spectrum beta-lactamase (ESBL) producing Enterobacterales.
Because third-generation cephalosporins exhibit specific activities against bacteria, a 30 µg cefotaxime disk should be used when performing Kirby-Bauer disk susceptibility tests for this antibiotic.
May cause hypersensitivity reactions (rashes, fever, eosinophilia, lymphadenopathy, GI
High doses or very prolonged use has been associated with neurotoxicity, neutropenia, agranulocytosis, thrombocytopenia, hepatitis, positive Coombs test, interstitial nephritis, and tubular necrosis. Except for tubular necrosis and neurotoxicity, these effects have an immunologic component.
may also alter gut flora, antibiotic-associated diarrhea can occur and allow the proliferation of resistant bacteria in the colon (superinfections).
Causes pain on IM injection; give IV over at least 3 to 5 minutes
Cefadroxil
First generation oral cephalosporin indicated in dogs and cats for bacterial cystitis or skin/soft tissue infections
time dependent and bactericidal against susceptible bacteria, and they act by inhibiting mucopeptide synthesis in the cell wall, which results in a defective barrier and an osmotically unstable spheroplast. The exact mechanism for this effect has not been definitively determined, but beta-lactam antibiotics have been shown to bind to several enzymes (eg, carboxypeptidases, transpeptidases, endopeptidases) in the bacterial cytoplasmic membrane that are involved in cell wall synthesis. The different affinities that various beta-lactam antibiotics have for these enzymes (also known as penicillin-binding proteins [PBPs]) help explain the differences in spectrums of activity of these drugs that are not explained by the influence of beta-lactamases. Like other β-lactam antibiotics, cephalosporins are generally considered to be more effective against actively growing bacteria. For bactericidal activity, cephalosporin levels should exceed bacterial MIC for ≈40% of the dose interval for staphylococcal infections and ≈60% of the dose interval for streptococcal infections
First-generation cephalosporins generally possess excellent coverage against most gram-positive pathogens (with the exception of enterococci). They have variable to poor coverage against most gram-negative pathogens. These drugs are active in vitro against streptococci, staphylococci, Proteus mirabilis, and some strains of Escherichia coli, Klebsiella spp, Actinobacillus spp, and Pasteurella spp. Methicillin-resistant staphylococci are resistant to this class of antibiotics. In vitro susceptibility is generally predictive of the potential for in vivo efficacy. Cefadroxil is inactive against Enterococcus spp, Pseudomonas spp, Rickettsia spp, mycobacteria, Mycoplasma spp, fungi, and viruses.
Usually well-tolerated; adverse GI effects (eg, anorexia, vomiting, diarrhea) may occur; hypersensitivity reactions unrelated to dose can occur as in other cephalosporins
May be administered with or without food; however, administering the drug with food may help prevent GI upset.
Severe renal impairment may require dose adjustment. Although cephalosporins (particularly cephalothin) have the potential for causing nephrotoxicity, at clinically used doses in patients with normal renal function, the risks for the occurrence of this adverse effect appear minimal.
High doses or prolonged use of cephalosporins have been associated with neurotoxicity, neutropenia, agranulocytosis, thrombocytopenia, hepatitis, positive Coombs test, interstitial nephritis, and tubular necrosis. Except for tubular necrosis and neurotoxicity, these effects have an immunologic component.
Cephalexin
First generation cephalosporin
Commonly used for bacterial skin infections in dogs and cats
Like other beta-lactams, cephalexin binds to and disrupts the actions of bacterial penicillin-binding proteins (ie, transpeptidase and carboxypeptidase), thereby interfering with bacterial cell wall synthesis and resulting in time-dependent bactericidal activity. The different affinities that various beta-lactam antibiotics have for these penicillin-binding proteins help explain the differences in spectrums of activity of these drugs that are not explained by the influence of beta-lactamases. Like other beta-lactam antibiotics, cephalosporins are generally considered to be more effective against actively growing bacteria. For bactericidal activity, cephalosporin levels should exceed bacterial MIC for at least 40% of the dose interval for staphylococcal infections and ≈60% of the dose interval for streptococcal infections.
generally possess excellent coverage against most gram-positive pathogens (excluding enterococci); they are active in vitro against streptococci and staphylococci. Because first-generation cephalosporins have variable coverage against most gram-negative pathogens, their usefulness for these bacteria is mainly for treatment of lower UTIs because of the high drug concentrations achieved in urine. With the exception of Bacteroides fragilis, most anaerobes are susceptible to the first-generation agents.
Cephalexin is not effective against Enterococcus spp, mycobacteria, Mycoplasma spp, Pseudomonas spp, Rickettsia spp, fungi, and viruses. Resistance is of increasing concern, particularly with methicillin-resistant staphylococci and extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales.
Contraindications include patients with history of hypersensitivity to cephalosporins.
Nephrotoxicity can occur (rare) during therapy with cephalexin, but patients that have renal dysfunction, are receiving other nephrotoxic drugs, or are geriatric may be more susceptible.
The most commonly reported adverse effects are GI in nature. lethargy, pruritus, salivation, tachypnea, and excitability in dogs, and emesis and fever in cats; rarely serious skin reactions; hypersensitivity reactions
minor changes to hemostasis (increase in PT and PTT) were noted but not considered clinically relevant
May be given with food has been noted
First Gen ceph - Interferes with bacterial cell wall synthesis
GI, hypersensitivity, caution with renal impairment
Ceftazidime
Third Generation Cephalosporin
Parenteral antibacterial primarily used for serious systemic Pseudomonas spp infections in dogs and cats
Bactericidal and acts via its inhibition of enzymes responsible for bacterial cell wall synthesis. The third-generation cephalosporins retain much of the gram-positive activity of the first- and second-generation agents but have expanded gram-negative activity. As with the second-generation agents, enough variability exists with individual bacterial sensitivities that susceptibility testing is necessary for most bacteria. Unlike most other third-generation cephalosporins, ceftazidime is considered an anti-pseudomonal cephalosporin, but resistance can be present. Ceftazidime is ineffective against extended-spectrum ß-lactamase (ESBL)–producing bacteria and methicillin-resistant staphylococci, as well as enterococci.
Because susceptibility of various bacteria to the third-generation cephalosporin antibiotics is unique to a given agent, ceftazidime-specific disks or dilutions must be used to determine susceptibility. Resistance of Pseudomonas spp to other third-generation cephalosporins does not necessarily indicate resistance to ceftazidime because of the poor anti-pseudomonal activity of most other cephalosporins.
Constant rate IV infusion or frequent parenteral administration may be necessary in dogs and cats with serious systemic Pseudomonas spp infections.
Use with caution in patients with renal insufficiency; dosing interval may need to be increased.
May cause hypersensitivity reactions, granulocytopenia, thrombocytopenia, diarrhea, and mild azotemia
May cause pain on IM injection; SC injection may be less painful.
3rd Gen Ceph - inhib enzymes bacterial cell wall synthesis
Used for Pseudomonas, May cause hypersens rxn
Cefovecin
Third generation cephalosporin
Injectable cephalosporin labeled in the US for treatment of skin infections in dogs and cats.
binds to several enzymes in the bacterial cytoplasmic membrane that are involved with cell wall synthesis (ie, penicillin-binding proteins [PBP] such as carboxypeptidases, transpeptidases, endopeptidases), resulting in cell wall lysis and cell death. Various beta-lactam antibiotics have different affinities for PBP, which helps explain the differences in spectrums of activity not explained by the influence of beta-lactamases1 Like other beta-lactams, cefovecin is a time-dependent bactericidal agent.
Cefovecin is active against gram-positive and gram-negative organisms, but it is not as active against gram-negative organisms as other antibiotics of this class (eg, cefotaxime, ceftazidime). It is active against susceptible strains of S intermedius, S canis (group G), and P multocida. Cefovecin is also active against S pseudintermedius, beta-hemolytic streptococci, Proteus spp, Porphyromonas spp, Prevotella spp, Fusobacterium spp, and Bacteroides spp. Cefovecin’s effectiveness against systemic (ie, non-UTI) E coli or other Enterobacterales (eg, Enterobacter spp) is limited because the drug’s extensive protein binding results in the inability to reach adequate free drug concentrations for an adequate period for these organisms.
Cefovecin is not active against Pseudomonas spp, methicillin-resistant staphylococci, enterococci, Bordetella bronchiseptica, or extended-spectrum beta-lactamase–producing bacteria. Extrapolation of results of other third-generation cephalosporins should be avoided because of the reduced activity of cefovecin against gram-negative organisms (ie, susceptibility to cefotaxime does not necessarily indicate susceptibility to cefovecin).
Cefovecin rapidly cleared spirochetes and reduced antibodies in dogs with experimentally induced Lyme borreliosis.
Effectiveness against systemic (non-UTI) Escherichia coli or other Enterobacterales (eg, Enterobacter spp) infections is limited because of high protein binding and the inability to reach adequate drug concentrations for an adequate period.
Long acting in dogs and cats but shorter acting in some other species, including birds and reptiles
Primary benefit is for patients with owners that have difficulty adhering to an oral dosing regimen or when oral antibiotics are not tolerated or absorbed.
Usually well tolerated, but common adverse events include vomiting, diarrhea, and anorexia, inj site reactions possible; mild to moderate increases in ALP, ALT, GGT, BUN, Creat; Hypersens reactions and death have been reported
there was an increase of blaCMY-2 (an extended spectrum beta-lactamase gene) and beta-lactam resistance in fecal E coli compared with dogs that received a placebo.
3rd Gen Ceph -Binds to cytoplasmic membrane in cell wall synthesis
Reduced gram negative activity; can persist in the body for up to 65 days; effective against lyme spirochetes
Ceftriaxone
Third Generation Cephalosporin
Injectable antibiotic used to treat serious bacterial infections
bactericidal and displays time-dependent killing. Third-generation cephalosporins retain the gram-positive activity of the first- and second-generation agents, but have much expanded gram-negative activity. This class of antibiotics is often chosen for their excellent gram-negative coverage and significantly less toxic potential (as compared with the aminoglycosides). As with the second-generation cephalosporins, enough variability exists with individual bacterial sensitivities that susceptibility testing is necessary.
Ceftriaxone is ineffective against methicillin-resistant staphylococci, enterococci, extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, and AmpC-producing Enterobacterales. It generally has excellent activity against gram-negative bacteria; however, it is not a good choice for Serratia spp, Pseudomonas spp, some Proteus spp, Citrobacter spp, and Enterobacter spp (“SPICE” organisms).
Achieves therapeutic concentrations in CNS; long half-life
Adverse effects include hypersensitivity reactions and injection site reactions (eg, skin tightness, induration).
Administer ceftriaxone IV over 30 minutes (or longer). Pain on IM injection is reduced when reconstituted with lidocaine.
3rd Gen Ceph
Reaches CNS
Cefpodoxime
Third Generation Cephalosporin
Oral antibacterial agent used to treat susceptible skin infections and UTIs in dogs
binds to several enzymes in the bacterial cytoplasmic membrane that are involved with cell wall synthesis (ie, penicillin-binding proteins [PBP], such as carboxypeptidases, transpeptidases, endopeptidases), resulting in cell wall lysis and cell death. Various beta-lactam antibiotics have different affinities for PBP, which helps explain the differences in spectrums of activity not explained by the influence of beta-lactamases. It is considered relatively resistant to bacterial beta-lactamases.
Although cefpodoxime is a broad-spectrum drug, it has much greater activity against gram-positive bacteria than against gram-negative bacteria. Despite it having activity against many gram-negative bacteria in the Enterobacteriaceae family, including many Escherichia spp, Proteus spp, Klebsiella spp, and Pasteurella multocida, minimum inhibitory concentrations (MICs) with cefpodoxime are often relatively higher than with other third-generation drugs (eg, cefotaxime, ceftazidime). Cefpodoxime has good activity against methicillin-susceptible staphylococci and many streptococci. It is effective against most anaerobic bacteria, but not Bacteroides fragilis. Cefpodoxime has no activity against fungi, viruses, or parasites.
Cefpodoxime is not effective against methicillin-resistant staphylococci, extended-spectrum beta-lactamase–producing gram-negative bacteria, AmpC-producing bacteria, including inducibly resistant bacteria that can appear susceptible in vitro (eg “SPACE” [Serratia spp, Pseudomonas spp, Acinetobacter spp, Citrobacter spp, Enterobacter spp] and “HECKYes” [Hafnia alvei, Enterobacter cloacae, Citrobacter freundii, Klebsiella aerogenes, Yersinia enterocolitica] organisms), Enterococcus spp, and B fragilis.
Due to potential differences between cefpodoxime and other third-generation cephalosporins, cefpodoxime-specific disks or dilutions should be used to determine susceptibility rather than susceptibility being inferred from other third-generation cephalosporins.
Contraindicated in patients with history of hypersensitivity to cephalosporins or other beta-lactams
Use with caution in patients with significant renal impairment.
The most likely adverse effects are GI in nature; may be given with food.
High doses or prolonged use of cephalosporins have been associated with neurotoxicity, neutropenia, agranulocytosis, thrombocytopenia, hepatitis, interstitial nephritis, and tubular necrosis. The risk for nephrotoxicity may be increased in patients with renal dysfunction. Longer prothrombin times have also been noted. Except for tubular necrosis and neurotoxicity, these effects have an immunologic component.
3rd Gen Ceph
Cefixime
Oral third-generation cephalosporin that may be useful in dogs and cats, but that has a limited spectrum compared to most other third-generation cephalosporins
inhibits bacteria cell wall synthesis. It is considered bactericidal. Cefixime’s primary spectrum of activity is against gram-negative bacteria in the family Enterobacteriaceae, including Escherichia spp, Proteus spp, and Klebsiella spp. It is resistant to penicillinases but is inactivated by extended spectrum beta-lactamases (EBSLs). Unlike veterinary third-generation cephalosporins, it has limited activity against gram-positive bacteria. Against streptococci, it is efficacious but has a limited effect. Cefixime is not efficacious against Bordetella spp, Campylobacter spp, Enterobacter spp, Proteus spp, Pseudomonas aeruginosa, and Enterococcus spp; it has limited efficacy against anaerobes. Because of the difference in the spectrum of cefixime compared to commonly tested third-generation cephalosporins (eg, ceftiofur, cefpodoxime, cefovecin), specific testing for cefixime susceptibility is required.
Contraindications include hypersensitivity to cefixime or other cephalosporins.
May need to adjust dose if the patient has renal disease
Adverse effects primarily include GI distress, but hypersensitivity reactions are possible.
3rd Gen Ceph
Cefoxitin
2nd Gen Cephalosporin/Cephamycin
Parenteral antimicrobial effective against most gram-positive cocci and gram-negative rods, and against some anaerobes
Cefoxitin is a cephamycin, not a true cephalosporin; however, it is usually classified as a second-generation antibacterial agent. Cefoxitin has activity against most gram-positive cocci, but activity is less on a per weight basis than with first-generation cephalosporin agents. Cefoxitin has better activity against Escherichia coli, Klebsiella spp, Campylobacter spp, Proteus spp, and other gram-negative bacteria compared to first-generation cephalosporin agents. Extended spectrum beta-lactamase (ESBL)-producing gram-negative bacteria are typically susceptible to cefoxitin in vitro but in vivo response is unpredictable.
Bacterial resistance to cefoxitin is a growing concern. Methicillin-resistant staphylococci and AmpC producing gram-negative bacteria are resistant to cefoxitin. Cefoxitin resistance is commonly used as an in vitro marker for methicillin-resistance in Staphylococcus aureus. Activity against enterococci and Pseudomonas spp is poor.
Potentially causes hypersensitivity reactions, thrombocytopenia, and diarrhea
Causes pain on IM injection; IV injections should be given over 3 to 5 minutes (or longer).
Dosage reductions may be needed for patients with renal insufficiency
Cephamycin, not true cephalosporin
Cefazolin
Injectable first generation cephalosporin antibiotic often used for surgical prophylaxis for gram-positive coverage
time dependent and bactericidal against susceptible bacteria, and they act by inhibiting mucopeptide synthesis in the cell wall, which results in a defective barrier and an osmotically unstable spheroplast. The exact mechanism for this effect has not been definitively determined, but beta-lactam antibiotics have been shown to bind to several enzymes in the bacterial cytoplasmic membrane that are involved with cell wall synthesis (ie, penicillin-binding proteins [PBP] such as carboxypeptidases, transpeptidases, endopeptidases), resulting in cell wall lysis and cell death. Various beta-lactam antibiotics have different affinities for PBP, which helps explain the differences in spectrums of activity not explained by the influence of beta-lactamases. Like other beta-lactam antibiotics, cephalosporins are generally considered to be more effective against actively growing bacteria.
Cefazolin exhibits activity against most gram-positive pathogens (excluding enterococci) and variable coverage against most gram-negative pathogens. Cephalosporins are active in vitro against streptococci, staphylococci, Proteus mirabilis, and some strains of Escherichia coli, Klebsiella spp, Actinobacillus spp, and Pasteurella spp. With the exception of Bacteroides fragilis, most anaerobes are susceptible to first-generation cephalosporins. Bacterial resistance is of increasing concern, particularly with methicillin-resistant staphylococci and extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales. Cefazolin is inactive against Enterococcus spp, Pseudomonas spp, Rickettsia spp, mycobacteria, Mycoplasma spp, fungi, and viruses.
Although the spectrum of activity among first-generation cephalosporins is similar, there may be differences in their individual MICs. Plasma concentrations of less than or equal to 2 micrograms/mL (16 micrograms/mL or less for lower urinary tract) are believed to be effective for most bacteria not inherently resistant to the drug or those that have acquired resistance. For bactericidal activity, cephalosporin levels should exceed bacterial MIC for at least 50% to 70% of the dosing interval. Because cefazolin is a time-dependent antibiotic, where time above MIC is the critical factor, IV CRI protocols may be used to maintain serum and tissue concentrations above MIC, although veterinary-specific protocols have not been published.
May cause hypersensitivity reactions
Use with caution in patients with severe renal impairment or with seizure disorders
potential to cause nephrotoxicity at clinically used doses in patients with normal renal function, risks for the occurrence of this adverse effect appear minimal.
High doses or prolonged use has been rarely associated with neurotoxicity, neutropenia, agranulocytosis, thrombocytopenia, hepatitis, positive Coombs test, interstitial nephritis, and tubular necrosis. These effects, with the exception of tubular necrosis and neurotoxicity, have an immunologic component. Cefazolin may be more likely than other cephalosporins to cause seizures at very high doses. A case of status epilepticus was reported after cefazolin was mistakenly injected into the subarachnoid space of a dog undergoing lumbar myelography
Can cause pain on IM injection; give IV slowly over 3 to 5 minutes (or more, as needed)
Cefuroxime
Oral and parenterally administered second-generation cephalosporin that is more active against some gram-negative bacteria than first-generation (eg, cephalexin, cefazolin) cephalosporins
time-dependent bactericidal antibiotic and acts by inhibiting cell wall synthesis. Its spectrum of activity is similar to that of cephalexin, but it is more active against gram-negative bacteria, including strains of Escherichia coli, Klebsiella pneumoniae, Salmonella spp, and Enterobacter spp. It is not effective against methicillin-resistant Staphylococcus spp, Pseudomonas spp, Serratia spp, or Enterococcus spp and it has little activity against Bacteroides fragilis. It is also ineffective against extended-spectrum beta-lactamase (ESBL)-producing bacteria.
Potentially useful in small animals when a cephalosporin is desired but there is resistance to first-generation cephalosporins, or when slightly enhanced gram-negative coverage is desired for surgical prophylaxis
Limited clinical experience in veterinary medicine
Adverse effects most commonly seen in small animal species are GI-related
1st gen ceph
Cefaclor
More active against some gram-negative bacteria than first-generation cephalosporins (eg, cephalexin, cefadroxil)
It is potentially useful when an oral cephalosporin is desired to treat bacterial infections that are susceptible to cefaclor but resistant to first-generation cephalosporins.
bactericidal and acts via inhibiting cell wall synthesis. Its spectrum of activity is similar to that of cephalexin, but it has a broader spectrum to include activity against gram-negative bacteria, including strains of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (but not most other Proteus). It is ineffective against enterococci, Enterobacter, most Pseudomonas spp, methicillin-resistant staphylococci, and extended-spectrum beta -lactamase (ESBL) producing gram-negative bacteria.
Limited clinical experience in veterinary medicine
Contraindications include hypersensitivity to cefaclor or other cephalosporins.
The most likely adverse effects in small animal species are GI related. Rare adverse effects reported include erythema multiforme, rash, increases in liver function tests, and transient increases in BUN and serum creatinine. High doses or prolonged use of cephalosporins have been associated with neurotoxicity, neutropenia, agranulocytosis, thrombocytopenia, hepatitis, interstitial nephritis, and tubular necrosis.
2nd Gen Ceph
Cefepime
Injectable fourth-generation cephalosporin that is more active against some gram-negative and gram-positive bacteria than third-generation cephalosporins
bactericidal and acts by inhibiting cell wall synthesis. It is classified as a fourth- generation cephalosporin, implying it has increased gram-negative activity (particularly against Pseudomonas spp) and better activity against many gram-positive bacteria than would be seen with the third-generation agents. Cefepime has activity against many gram-positive aerobes, including staphylococci, streptococci, and Enterobacteriaceae (eg, Escherichia coli, Enterobacter spp). Cefepime has good activity against many gram-negative bacteria and has better activity (than other cephalosporins) against many Enterobacteriaceae, including Enterobacter spp, E coli, Proteus spp, and Klebsiella spp. It is considered an anti-pseudomonal cephalosporin, with activity against Pseudomonas spp being similar to, or slightly less than, that of ceftazidime (a third-generation cephalosporin). It has limited activity against extended-spectrum beta-lactamase (ESBL) producing bacteria.
Cefepime also has activity against certain atypical organisms like Mycobacterium avium-intracellulare complex but is not a suitable antibiotic for monotherapy.
Some anaerobes are susceptible to cefepime; however, Bacteroides spp is typically resistant.
Cefepime does not readily induce beta-lactamases and is highly resistant to hydrolysis by them. Cefepime is ineffective against enterococci, Listeria monocytogenes, and methicillin-resistant staphylococci.
Potentially useful for treating dogs with serious infections, where more commonly used antimicrobials are not options
Limited clinical experience with this drug in veterinary medicine
Adverse GI effects (eg, diarrhea) are possible. Injection site reactions have occurred following IM injections in dogs.
4th Gen Ceph
more active against some gram - and gram + bacteria
Cefotetan
2nd Gen Cephalosporin/Cephamycin
similar to cefoxitin, with more activity against gram-negative bacteria than first- and other second-generation cephalosporins
not affected by extended spectrum beta-lactamases (ESBLs) in vitro. It is usually bactericidal and acts by inhibiting mucopeptide synthesis in the bacterial cell wall.
As with second-generation cephalosporins, cefotetan has activity against gram-positive and gram-negative bacteria, with enhanced gram-negative activity compared with first-generation cephalosporins. Cefotetan’s in vitro activity against aerobes include Escherichia coli, Proteus spp, Klebsiella spp, Salmonella spp, Staphylococcus spp, and Streptococcus spp. It also has efficacy against most anaerobes, including Actinomyces spp, Clostridium spp, Propionibacterium spp, and many strains of Bacteroides spp. Cefotetan is generally ineffective against Pseudomonas aeruginosa and enterococci, as well as methicillin-resistant staphylococci. Because in vitro susceptibility to cefotetan is rarely tested, cefoxitin susceptibility is used for clinical decision making.
Pharmacokinetic profile of cefotetan is better (and it may be more effective against Escherichia coli in dogs) than cefoxitin, although cefotetan is rarely used in animals and clinical data are lacking.
Contraindications include hypersensitivity to cefotetan or cephalosporins.
little information on the adverse effect profile of this medication in veterinary species, but it appears to be well tolerated. Adverse effects are unlikely; however, cefotetan could increase risk for bruising or bleeding. Hypersens possible.
If severe renal dysfunction occurs with cefotetan, may need to increase time between doses.
2nd Gen Ceph/cephamycin
Not affected by extended spectrum beta lactamases
