Most of the drugs in this class start with “cef-,” except for a few such as the first one on the market known as cephalexin (Keflex).
Unlike bacteriostatic agents, which simply stop bacteria from reproducing, bactericidal agents actually cause bacterial cell death. They disrupt cell wall synthesis leading to cell wall damage, causing lysis and death.
First-generation cephalosporins are primarily used to fight against gram positive infections, while successive generations have enhanced activity in treating gram negative infections.
Allergic reactions are the most frequent adverse events occurring with the use of cephalosporins. The most common symptom is a maculopapular rash that develops several days after the onset of use. If signs of allergy appear such as a rash, hypotension, urticaria, or difficulty breathing, the use of cephalosporins should be discontinued.
Thrombophlebitis can occur during IV infusion. Minimize its occurrence by rotating the infusion site and administering the IV medication slowly.
The cephalosporin, cefotetan, may cause bleeding tendencies due to reduction of prothrombin levels. Implement caution when using concurrently with anticoagulants or thrombolytic agents and monitor for signs of bleeding.
Cephalosporins are eliminated by the kidneys; therefore, individuals with preexisting renal impairment should not be given this drug or dosages must be reduced in order to prevent accumulation of toxic levels.
The combination of calcium with the cephalosporin ceftriaxone can form potentially fatal precipitates; therefore, the two should never be given together by the same route and should not be reconstituted with solutions containing one or the other. In neonates, the combination has caused death from depositing precipitates in the lungs and kidneys.
The cephalosporin cefotetan can induce a state of alcohol intolerance. The patient should be instructed to not have any form of alcohol when taking this medication as their concurrent use could cause a disulfiram-like reaction (flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, low blood pressure, and anxiety).
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