ID Board Review/Antimicrobial Therapy/Antibacterials/β-Lactams/Cephalosporins

Cephalosporins are a large and varied class of antibiotics that is conceptually split into five different "generations." As the generations progress, so do their gram-negative coverages.

First Generation
The 1st generation has a fair amount of gram-positive coverage (including S. aureus) with very basic gram-negative coverage. This is why 1st generation cephalosporins are often used for surgical prophylaxis to prevent skin/surgical site infections.
 * Cefazolin (Ancef)
 * Cefalexin (Keflex)

= Second Generation = The 2nd generation has less gram-positive coverage than the 1st generation, but has better gram-negative coverage.
 * Cefuroxime
 * Cefoxitin

= Third Generation = The 3rd generation has more gram-negative coverage than the 2nd generation, but less gram-positive coverage. Ceftazidime stands out as the only 3rd generation cephalosporin with antipseudomonal coverage.
 * Ceftriaxone (Rocephin)
 * Cefdinir (Omnicef)
 * Cefpodoxime (Vantin)
 * Cefixime
 * Cefotaxime
 * Ceftazidime Antipseudomonal

= Fourth Generation = The 4th generation, while small, has good pseudomonal spp coverage (hence why many patients are started on a 4th generation cephalosporin, then de-escalated once pseudomonas is ruled out).
 * Cefepime

= Fifth Generation = The 5th generation has the same gram-negative coverage as the 3rd and 4th generations, but has significantly better gram-positive coverage, including MSSA, MRSA and S. pneumoniae, and is considered to be a very broad-spectrum.
 * Ceftaroline
 * Ceftolozane-Tazobactam (Zerbaxa)
 * Ceftobiprole-Avibactam (Avycaz)