Cephalosporins differ structurally from penicillins by having the β-lactam ring as a 6 member ring, compared to the 5 member ring structure of the penicillins. These agents are widely used in pediatric practice, both in oral and parenteral formulations.
The 2nd generation cephalosporins have better activity against gram-negative infections than do 1st generation cephalosporins and are used to treat respiratory tract infections, urinary tract infections, and soft-tissue infections. A variety of orally administered 2nd generation agents (cefaclor, cefprozil, loracarbef, cefpodoxime) are commonly used in the outpatient management of sinopulmonary infections.
The 3rd generation cephalosporins are used for serious pediatric infections, including meningitis and sepsis. Ceftazidime is highly active against most strains of P. aeruginosa, making this a useful agent for febrile, neutropenic oncology patients.
Another class of 4th generation cephalosporins is indicated for treatment of pediatric meningitis, has activity against P. aeruginosa, and retains good activity against methicillin-susceptible staphylococcal infections.
| Cephalosporins | 1st Generation | 2ndGeneration | Cephamycins | 3rd Generation | 4th Generation |
|---|---|---|---|---|---|
| Parenteral | Cefazolin | Cefamandole | Cefmetazole | Cefoperazole | Cefepime |
| Cephalothin | Cefonicid | Cefotetan | Cefotaxime | Cefpirome | |
| Cephapirin | Cefuroxime | Cefoxitin | Ceftazidime | ||
| Cephradine | Ceftizoxime | ||||
| Ceftriaxone | |||||
| Oral | Cefadroxil | Cefaclor | Cefdinir | ||
| Cephalexin | Cefprozil | Cefditoren | |||
| Cephradine | Cefuroxime-axetil | Cefixime | |||
| Loracarbef | Cefpodoxime | ||||
| Ceftibuten |
Reference:
Nelson Textbook of Pediatrics 18th Edition