Next generation cephalosporins

Cephalosporins are a large group of antibiotics derived from the mold Acremonium (previously called Cephalosporium). Cephalosporins are bactericidal (kill bacteria) and work in a similar way to penicillins. They bind to and block the activity of enzymes responsible for making peptidoglycan, an important component of the bacterial cell wall. They are called broad-spectrum antibiotics because they are effective against a wide range of bacteria.

After the first cephalosporin was discovered in 1945, scientists improved the structure of cephalosporins to make them more effective against a wider range of bacteria. Each time the structure changed, a new "generation" of cephalosporins were made. There are five generations of cephalosporins. Next generation cephalosporins were the fifth generation of cephalosporins to be developed.

What are next generation cephalosporins used for?

Next generation cephalosporins have activity against multi-resistant Staphylococcus aureus (MRSA), gram-positive bacteria and some gram-negative bacteria. Ceftaroline is the only next-generation cephalosporin available in the United States. In adults and children aged two years and older it is approved to treat:

• Pneumonia that is acquired in the community (not in hospital)
• Skin and skin structure infections.

What are the differences between next generation cephalosporins?

Ceftaroline is currently the only next generation cephalosporin available in the United States. It is active against methicillin-resistant Staphylococcus aureus (MRSA) and gram-positive bacteria. It also retains the activity of the later-generation cephalosporins and is effective against susceptible gram-negative bacteria.

Are next generation cephalosporins safe?

Next generation cephalosporins are generally safe, with low toxicity and good efficacy against susceptible bacteria.

Allergic reactions have been reported with all cephalosporins including ceftaroline and symptoms may include a rash, hives (urticaria), swelling, or rarely, anaphylaxis. Up to 10% of people with a history of penicillin allergy will also be allergic to cephalosporins.

A positive Coombs test (a test that checks your blood for antibodies that attack red blood cells) has been reported in up to 18% of children and 11% of adults taking ceftaroline. This may be associated with red blood cell hemolysis and drug-induced hemolytic anemia should be suspected if anemia develops during or after treatment.

Rarely, some people may develop a super-infection due to overgrowth of a naturally occurring bacterium called Clostridium difficile, following use of any antibiotic, including cephalosporins. Symptoms may include severe diarrhea.

Rarely, seizures have been reported with ceftaroline; the risk may be greatest in those with kidney disease.

For a complete list of severe side effects, please refer to the ceftaroline drug monograph.

What are the side effects of next generation cephalosporins?

Ceftaroline generally causes few side effects. The most common side effects reported include:

• Abdominal pain
• Constipation
• Diarrhea
• Dyspepsia
• A headache
• Insomnia
• Itchy skin
• Gastritis
• Nausea
• Rash
• Vomiting.

Transient increases in liver enzymes have also been reported

For a complete list of side effects, please refer to the ceftaroline drug monograph.