4 th and 5 th generation cephalosporins. Naderi HR Associate professor of Infectious Diseases

Transcription

1 4 th and 5 th generation cephalosporins Naderi HR Associate professor of Infectious Diseases

2 Classification

3 Forth generation: Cefclidine, cefepime (Maxipime),cefluprenam, cefoselis,cefozopran, cefpirome (Cefrom), cefquinome. These cephems are also sometimes grouped with fourth-generation cephalosporins: Oxacephems: flomoxef Note:Cefquinome is not approved for human use. It is for veterinary medicine.

4 Gram-positive: They are extended-spectrum agents with similar activity against Gram-positive organisms as first-generation cephalosporins. Gram-negative: They have a greater resistance to β-lactamases than the third-generation cephalosporins. Many can cross the blood brain barrier and are effective in meningitis. They are also used against Pseudomonas aeruginosa.

5 Cefepime has been shown to be active against most isolates of the following microorganisms: Aerobic Gram-Negative Microorganisms Enterobacter Escherichia coli Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa

6 Aerobic Gram-Positive Microorganisms Staphylococcus aureus (methicillin-susceptible isolates only) Streptococcus pneumoniae Streptococcus pyogenes (Lancefield s Group A streptococci) Viridans group streptococci Not proved in clinical practice: Staphylococcus epidermidis (methicillin-susceptible isolates only) Staphylococcus saprophyticus Streptococcus agalactiae (Lancefield s Group B streptococci)

7 Aerobic Gram-Negative Microorganisms Acinetobacter calcoaceticus subsp. lwoffii Citrobacter diversus Citrobacter freundii Enterobacter agglomerans Haemophilus influenzae (including beta-lactamase producing isolates) Hafnia alvei Klebsiella oxytoca Moraxella catarrhalis (including beta-lactamase producing isolates) Morganella morganii Proteus vulgaris Providencia rettgeri Providencia stuartii Serratia marcescens

8 Most isolates of enterococci, eg, Enterococcus faecalis, and methicillin-resistant staphylococci are resistant to cefepime. Cefepime is inactive against many isolates of Stenotrophomonas (formerly Xanthomonas maltophilia and Pseudomonas maltophilia). Cefepime is inactive against most isolates of Clostridium difficile.

9 Recommended Dosage Schedule for Cefepime :

10 Recommended Dosage Schedule for Cefepime based on GFR:

11 Fifth generation [MRSA-Active]: Ceftobiprole, Ceftaroline, Ceftolozane.

12 Ceftobiprole has been described as "fifthgeneration" cephalosporin, though acceptance for this terminology is not universal. Ceftobiprole has powerful antipseudomonal characteristics and appears to be less susceptible to development of resistance. Ceftaroline has also been described as "fifthgeneration" cephalosporin, but does not have the antipseudomonal or VRE coverage of ceftobiprole.

13 Ceftaroline has been shown to be active against most of the following bacteria: Skin Infections Gram-positive bacteria Staphylococcus aureus (including methicillin-susceptible and -resistant isolates) Streptococcus pyogenes Streptococcus agalactiae Gram-negative bacteria Escherichia coli Klebsiella pneumoniae Klebsiella oxytoca

14 Community-Acquired Bacterial Pneumonia (CABP) Gram-positive bacteria Streptococcus pneumoniae Staphylococcus aureus (methicillin-susceptible isolates only) Gram-negative bacteria Haemophilus influenzae Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli

15 Dosage of Teflaro by Infection: Infection Dosage Frequency Infusion Time (hours) Recommended Duration of Total Antimicrobial Treatment Acute Bacterial Skin and SkinStructure Infection (ABSSSI) 600 mg Every 12 hours days Community- Acquired Bacterial Pneumonia (CABP) 600 mg Every 12 hours days

16 Dosage of Teflaro in Patients with Renal Impairment: Estimated CrCl a (ml/min) Recommended Dosage Regimen for Teflaro >50 No dosage adjustment necessary >30 to </= mg IV (over 1 hour) every 12 hours 15 to </= mg IV (over 1 hour) every 12 hours End-stage renal disease, including hemodialysis b 200 mg IV (over 1 hour) every 12 hours c