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American Academy of Pediatrics
Article

Cephem Antibiotics: Wise Use Today Preserves Cure for Tomorrow

Sarah Parker, Michelle Mitchell and Jason Child
Pediatrics in Review November 2013, 34 (11) 510-524; DOI: https://doi.org/10.1542/pir.34-11-510
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Sarah Parker
*Division of Pediatric Infectious Diseases, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, CO.
†Antimicrobial Stewardship Program, Children’s Hospital Colorado, Aurora, CO.
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Michelle Mitchell
*Division of Pediatric Infectious Diseases, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, CO.
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Jason Child
†Antimicrobial Stewardship Program, Children’s Hospital Colorado, Aurora, CO.
‡Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO.
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  1. Sarah Parker, MD*,†
  2. Michelle Mitchell, MD*
  3. Jason Child, PharmD†‡
  1. *Division of Pediatric Infectious Diseases, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, CO.
  2. †Antimicrobial Stewardship Program, Children’s Hospital Colorado, Aurora, CO.
  3. ‡Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO.
  • Author Disclosure

    Drs Parker, Mitchell, and Child have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

  • Abbreviations:
    CAP:
    community-acquired pneumonia
    CLSI:
    Clinical Laboratory Standards Institute
    CSF:
    cerebrospinal fluid
    FDA:
    Food and Drug Administration
    GAS:
    group A streptococcus
    IM:
    intramuscular
    IV:
    intravenous
    MIC:
    mean inhibitory concentration
    MRSA:
    methicillin-resistant Staphylococcus aureus
    MSSA:
    methicillin-susceptible Staphylococcus aureus
    PBP:
    penicillin-binding protein
    PD:
    pharmacodynamic
    PK:
    pharmacokinetic
    PRSP:
    penicillin-resistant Streptococcus pneumoniae
    UTI:
    urinary tract infection
  • Editor’s Note

    In the spirit of last month’s issue emphasizing “Doing Less” and using evidenced-based guidelines for treating pneumonia and sinusitis, we present the following feature on the judicious use of cephalosporins.Joseph A. Zenel, MDEditor-in-Chief

    Practice Gap

    Although cephem antibiotics are important in a pediatrician’s armamentarium, they are overused to the detriment of patients, hospitals, and communities, despite the availability of sound alternatives. Going back to the basics on mechanisms of action, resistance, and pharmacokinetic and pharmacodynamic principles facilitates smarter use and preserves cures for tomorrow.

    Objectives

    After reading this article, readers should be able to:

    1. Describe in a general manner the mechanism of action, resistance, and pharmacokinetic and pharmacodynamic principles of cephem antibiotics.

    2. Describe the advantages and disadvantages of oral cephem antibiotics compared with amoxicillin and amoxicillin–clavulanic acid.

    3. Describe appropriate clinical situations in which to use cephem antibiotics.

    4. Describe appropriate clinical situations where cephems are commonly used but could reasonably be replaced with an alternative, non-cephem antimicrobial.

    Background

    The cephem antibiotics were first deployed in the 1960s but did not expand into broad use until the 1970s with the development of useful semisynthetic derivatives. The cephem class includes the cephalosporins and the cephamycins, of which more than 22 antibiotics are now in clinical use (Table 1). There is no doubt that the cephem antibiotics are important weapons in a practitioner’s armamentarium; they are the most widely prescribed and largest selling class of antibiotics, with $8.5 billion spent yearly worldwide. (1)

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    Table 1.

    Compiled Cephem and Comparative Penicillin Agent Pharmacokinetic and Pharmacodynamic Data

    That said, cephems are also arguably the most inappropriately used antibiotics in pediatrics. Approximately 40% of pediatric antibiotic use is inappropriate. This …

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    In this issue

    Pediatrics in Review: 34 (11)
    Pediatrics in Review
    Vol. 34, Issue 11
    1 Nov 2013
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    Cephem Antibiotics: Wise Use Today Preserves Cure for Tomorrow
    Sarah Parker, Michelle Mitchell, Jason Child
    Pediatrics in Review Nov 2013, 34 (11) 510-524; DOI: 10.1542/pir.34-11-510

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    Cephem Antibiotics: Wise Use Today Preserves Cure for Tomorrow
    Sarah Parker, Michelle Mitchell, Jason Child
    Pediatrics in Review Nov 2013, 34 (11) 510-524; DOI: 10.1542/pir.34-11-510
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    • Article
      • Editor’s Note
      • Practice Gap
      • Objectives
      • Background
      • Cephem Structure, Mechanism of Action, and Microbial Resistance
      • Cephem Pharmacokinetics and Pharmacodymics
      • Allergy, Cross-reactivity and Adverse Effects
      • Use of Cephems in Common Clinical Situations: Common Indications and Choices
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