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Updated: Aug 15, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Oral cephalosporins in perspective

G H Smith1

  • 1Division of Clinical Pharmacy, University of Arizona, Tucson 85721.

DICP : the Annals of Pharmacotherapy
|January 1, 1990
PubMed

Insights

Oral cephalosporins offer limited advantages over older antibiotics for common infections. Newer agents are not clearly superior, suggesting they should be reserved for treatment failures or intolerance to first-line options.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Medicine

Background:

  • Oral cephalosporins have been used for 25 years to treat various infections.
  • Newer agents show increased in vitro activity against specific bacteria like Haemophilus influenzae and Branhamella catarrhalis.
  • These newer agents are often prescribed for pediatric otitis media and respiratory tract infections.

Purpose of the Study:

  • To evaluate the clinical efficacy of newer oral cephalosporins compared to older therapies.
  • To determine the optimal role of oral cephalosporins in ambulatory patient infections.
  • To assess the cost-effectiveness and therapeutic positioning of different oral antibiotic classes.

Main Methods:

  • Review of published clinical trials comparing oral cephalosporins with other antibiotics.
  • Analysis of in vitro activity data against common respiratory and skin pathogens.
  • Evaluation of treatment outcomes for infections of the respiratory tract, middle ear, skin, urinary tract, and musculoskeletal system.

Main Results:

  • Clinical trials have not demonstrated clear superiority of newer oral cephalosporins over older treatments for common infections.
  • Newer cephalosporins (cefaclor, cefuroxime axetil, cefixime) exhibit enhanced activity against beta-lactamase-producing H. influenzae and B. catarrhalis.
  • Efficacy of newer cephalosporins is comparable to older agents when treating infections caused by susceptible organisms.

Conclusions:

  • Oral cephalosporins, particularly newer agents, should be reserved for second- or third-line therapy.
  • Reserve use is recommended when first-line agents like amoxicillin or trimethoprim/sulfamethoxazole fail or cause intolerance.
  • Less expensive and equally efficacious alternatives like erythromycin/sulfisoxazole and amoxicillin/clavulanate potassium exist for second-line treatment.

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