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- Sarah Parker, MD*,†
- Michelle Mitchell, MD*
- Jason Child, PharmD†‡
- *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.
- ‡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.
- 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, MD
Editor-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:
Describe in a general manner the mechanism of action, resistance, and pharmacokinetic and pharmacodynamic principles of cephem antibiotics.
Describe the advantages and disadvantages of oral cephem antibiotics compared with amoxicillin and amoxicillin–clavulanic acid.
Describe appropriate clinical situations in which to use cephem antibiotics.
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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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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- 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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