Cephalosporins: Uses, common brands, and safety info

Cephalosporin antibiotics treat a variety of bacterial infections. Some infections that cephalosporins can be used to treat include respiratory tract infections, otitis media (middle ear infection), strep throat, skin infections, skin structure infections, bone infections, and urinary tract infections. 

Cephalosporins work by preventing bacteria from making cell walls. Stopping cell wall synthesis causes the bacteria to die. Cephalosporins are similar to penicillin. All drugs in the cephalosporin class are approved by the FDA (United States Food and Drug Administration) and are available as prescription drugs. 

Cephalosporins, like other antibiotics, can only treat bacterial infections and are not effective against viral infections such as the common cold, flu, or COVID-19. Taking an antibiotic for a viral infection will not help treat the viral infection, and it can increase the development of drug-resistant bacteria. Continue reading to learn all about cephalosporins, including their names, uses, and safety information. 

Other cephalosporins (injectable)

The following cephalosporins are available in injectable form and are usually administered in hospitals or other clinical settings. 

• Ancef*, Kefzol* (cefazolin) 

• Claforan* (cefotaxime)

• Fortaz, Tazicef (ceftazidime)

• Maxipime (cefepime)

• Mefoxin* (cefoxitin) 

• Rocephin* (ceftriaxone)

• Zinacef* (cefuroxime)

*Brand name discontinued in the U.S.; only the generic is available

Also, some cephalosporins are formulated in combination with a beta-lactamase (β-lactamase) inhibitor to combat resistant bacteria. These include:

• Avycaz (ceftazidime/avibactam)

• Zerbaxa (ceftolozane/tazobactam)

What are cephalosporins?

Cephalosporins are a group of antibiotics, or antimicrobials, known as beta-lactam antibiotics or β-lactam antibiotics. They can be used for various bacterial infections such as respiratory infections, skin infections, bone infections, and urinary tract infections. They cannot be used to treat a viral infection. 

How do cephalosporins work?

Cephalosporins are bactericidal. This means that they kill bacteria. Cephalosporins stop bacteria from building cell walls. 

Some types of bacteria can develop resistance to antibiotics by changing their structure. Some cephalosporins are formulated to include a drug known as a beta-lactamase inhibitor, which can fight bacteria that would usually be resistant to cephalosporins.

What are cephalosporins used for?

Cephalosporins are broad-spectrum antibiotics. This means they have a broad spectrum of activity and can treat a variety of bacterial infections. They do not work against viral infections, such as the common cold, flu, or COVID-19. The bacterial infections that cephalosporins can treat vary by product. Below is a general list of some of the infectious diseases that cephalosporins can treat:

• Skin infections and soft tissue infections (such as cellulitis and abscesses)

• Bone infections 

• Respiratory tract infections (such as bronchiolitis)

• Acute bacterial exacerbation of chronic bronchitis

• Urinary tract infections

• Biliary tract infections 

• Bloodstream infections 

• Otitis media (middle ear infection)

• Sinusitis

• Tonsillitis 

• Surgical or dental prophylaxis (to prevent infection)

• Meningitis 

• Gonorrhea

• Lyme disease

• Febrile neutropenia

• Intra-abdominal infection

• Pelvic inflammatory disease

Types of cephalosporins 

Cephalosporins are grouped into generations, depending on what kind of bacteria they work against. Cephalosporins work against many different types of bacteria, as outlined below. However, cephalosporins do not work against certain bacteria called enterococci. Most cephalosporins do not work against methicillin-resistant staphylococci (except for ceftaroline). Also, most cephalosporins do not work against anaerobic gram-negative bacilli (except for cefotetan and cefoxitin). 

A quick primer on Gram-positive and Gram-negative bacteria:

A Gram stain is a test. It tests for bacteria at the site of an infection (such as the throat, lungs, wounds, or genitals) or in the blood or urine. Bacterial infections are categorized as Gram-positive or Gram-negative, based on how the bacteria react to the Gram stain. A Gram stain is purple. When the stain is combined with the bacteria (taken from the patient), it will stay purple (indicating a Gram-positive infection) or turn pink or red (indicating a Gram-negative infection). 

Some examples of Gram-positive infections are MRSA (methicillin-resistant Staphylococcus aureus), strep throat, and toxic shock. 

Some examples of Gram-negative infections include pneumonia, urinary tract infections, gonorrhea, and salmonella. 

There are five generations of cephalosporins.

First-generation cephalosporins

First-generation cephalosporins are effective against Gram-positive staphylococci and streptococci. Oral first-generation cephalosporins, such as cefadroxil or cephalexin, are often used for uncomplicated skin and soft tissue infections. Parenteral (injectable) cefazolin is commonly used for endocarditis due to MRSA and to prevent infection before certain types of surgery.

Second-generation cephalosporins

Second-generation cephalosporins are effective against Gram-positive staphylococci and streptococcus and certain Gram-negative bacteria. Examples of second-generation cephalosporins include cefuroxime, cefprozil, and cefaclor. 

Third-generation cephalosporins

Third-generation cephalosporins have antibacterial activity against Haemophilus influenzae and some Enterobacter bacteria (such as Klebsiella pneumoniae and Escherichia coli). Most third-generation cephalosporins are active against some Gram-positive bacteria. Examples of third-generation cephalosporins include ceftriaxone and cefotaxime.

Fourth-generation cephalosporin

Cefepime is a fourth-generation cephalosporin. It is active against Gram-positive and Gram-negative bacteria. 

Fifth-generation cephalosporins

The fifth-generation cephalosporin ceftaroline is active against MRSA, penicillin-resistant streptococci, and ampicillin-susceptible and beta-lactamase-producing Enterococcus faecalis. It does not work against Pseudomonas bacteria (such as Pseudomonas aeruginosa).

Who can take cephalosporins?

In appropriate candidates, cephalosporin can be a safe and effective treatment. Before taking a cephalosporin, tell your doctor about your medical conditions and history and any medications you take, including prescription drugs, OTC medicines, and vitamins or supplements. Having an accurate and complete medical history will ensure that your provider can make the best treatment decision for you. 

Also, when you take a cephalosporin, finish the entire course of treatment as prescribed by your doctor. For example, do not stop the medication if you feel better on day four when you are supposed to take it for ten days. Stopping the medication early can cause bacteria to return. If you have bothersome side effects, feel worse, or have other concerns, consult your healthcare provider for medical advice.

Can men take cephalosporins?

Men can take cephalosporins for a bacterial infection (or prevention of a bacterial infection as indicated), provided they are not allergic to cephalosporins or penicillins or do not fall into a restricted category for the particular cephalosporin. Your healthcare provider can determine if a cephalosporin is appropriate for you. 

Can women take cephalosporins?

Women can take cephalosporins to prevent or treat bacterial infections (as indicated) if not allergic to penicillins or cephalosporins. If you are pregnant, planning to become pregnant, or breastfeeding, consult your healthcare provider before taking a cephalosporin. 

Can children take cephalosporins?

Yes, children can take cephalosporins. The dosage depends on the child’s weight, age, and the bacterial infection the cephalosporin is being used to treat. Consult your child’s pediatrician for more information. 

Can seniors take cephalosporins?

Generally, older adults can take cephalosporins as long as they are not allergic and do not fall into a restricted category for the particular cephalosporin. However, there are some exceptions. This is why it is essential to talk to the doctor about any medical conditions you have and your medical history. 

For example, cephalexin is processed by the kidney. People with kidney problems may be more likely to have a toxic reaction (such as seizures) to cephalexin. Since older adults are more likely to have kidney problems, the manufacturer suggests being cautious when selecting the dose.

Are cephalosporins safe?

Cephalosporin recalls

• Ceftazidime recall (April 20, 2020)

• Ceftriaxone recall (January 5, 2019)

Cephalosporins restrictions

Do not take a cephalosporin if you have a history of an allergic reaction to another cephalosporin. If you have a history of a penicillin allergy or hypersensitivity, ask your doctor. Cephalosporins should be used with caution in people who have had an allergic reaction to penicillin. Up to 10% of people who are allergic to penicillin may be allergic to cephalosporins. 

Some cephalosporins, such as cephalexin, have been associated with seizures, especially in people with kidney problems who took the full dosage. Use with caution in people with kidney problems. 

Also, people with kidney or liver problems, a poor state of nutrition, or people who are taking certain cephalosporins, such as cephalexin, for a long time, are at risk for a prolonged prothrombin time (the time it takes for blood to clot). These patients should be monitored if treated with a cephalosporin.

For more information about restrictions for each drug, refer to the monograph for each drug. 

Can you take cephalosporins while pregnant or breastfeeding?

Cephalosporins have not been thoroughly studied in human pregnancy. However, a cephalosporin may be prescribed to a pregnant woman if the doctor decides that it is necessary. Cephalosporins may enter breast milk. Consult your healthcare provider about cephalosporin use while breastfeeding.

Are cephalosporins controlled substances?

No, cephalosporins are not controlled substances. 

Common cephalosporins side effects

As with any medication, cephalosporins have side effects. The most common adverse effects of cephalosporins include:

• Nausea 

• Vomiting 

• Diarrhea 

• Rash 

• Abdominal pain 

• Appetite loss

• Headache 

• Dizziness 

• Injection site reactions like pain and swelling (for parenteral, or non-oral, forms of cephalosporins)

Serious side effects are less common. Serious side effects of cephalosporin follow.

• Clostridium difficile-

  associated diarrhea (CDAD) is a type of diarrhea that is associated with antibiotics. Symptoms can range from mild diarrhea to fatal colitis. CDAD may occur during antibiotic use or anytime up to two months after antibiotic use. 

• Allergic reactions may occur. Before taking a cephalosporin, notify your doctor of any allergies, especially if you are allergic to any cephalosporin or penicillin (such as penicillin, amoxicillin, or Augmentin). If you are taking a cephalosporin and have symptoms of a severe allergic reaction, such as hives, difficulty breathing, or swelling of the lips, tongue, or face, seek emergency medical help immediately.

This is not a complete list of side effects. Other side effects can occur. Talk to your healthcare professional about what side effects to expect and how to address them. 

How much do cephalosporins cost?

Cephalosporins vary in price. With their widespread generic availability, a prescription for cephalosporin is usually not too expensive. You can reduce the cost of your cephalosporin prescription by using a free SingleCare card or coupon, saving up to 80% on prescription costs.