Cephalosporins: Broad Spectrum Antibiotics-An Updated Review for Healthcare Professionals

Document Type : Original Article

Authors

Ministry of National Guard, Saudi Arabia

Abstract

Background: Cephalosporins are cornerstone β-lactam antibiotics arranged into five generations that progressively expand gram-negative activity while preserving gram-positive coverage across common and severe infections.

Aim: To synthesize practice-oriented guidance on spectrum, mechanisms, pharmacokinetics, indications, safety, contraindications, monitoring, and toxicity.

Methods: Narrative review of the supplied article integrating generational profiles, cefiderocol approvals, population-specific dosing, adverse effects, and stewardship themes.

Results: First generation targets staphylococci/streptococci; second adds respiratory gram-negatives and anaerobes; third broadens Enterobacteriaceae with CNS penetration (ceftazidime provides antipseudomonal activity); fourth-generation cefepime adds β-lactamase stability and antipseudomonal activity; fifth-generation ceftaroline uniquely covers MRSA. Cefiderocol, a siderophore cephalosporin, is FDA-approved for complicated UTI and ventilator-associated pneumonia due to resistant gram-negative bacilli. Safety issues include hypersensitivity, drug-induced immune hemolytic anemia, N-methyl-thiotetrazole–associated hypoprothrombinemia and disulfiram-like reactions, and antibiotic-associated Clostridioides difficile colitis. Contraindications include cephalosporin allergy, anaphylaxis to β-lactams, and neonatal ceftriaxone in hyperbilirubinemia or with calcium. Monitoring focuses on renal function, PT/INR, and hemolysis labs; cefepime neurotoxicity is the hallmark of overdose, and careful dose adjustment in renal impairment is essential.

Conclusion: Cephalosporins remain versatile and effective; optimal outcomes require tailored selection and stewardship, while cefiderocol extends options against carbapenem-resistant gram-negatives

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Egyptian Journal of Chemistry
Volume 68, Issue 13 - Serial Number 13
(In Loving Memory of Late Professor Doctor”Zeinab M. Nofal” In progress
December 2025
Pages 1161-1174

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History

  • Receive Date: 15 July 2025
  • Revise Date: 17 September 2025
  • Accept Date: 02 October 2025

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