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Updated: Oct 12, 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

Safety of cefotaxime and other new beta-lactam antibiotics

R H Parker, S Park

    The Journal of Antimicrobial Chemotherapy
    |September 1, 1984
    PubMed

    Insights

    Newer beta-lactam antibiotics like latamoxef and cefoperazone cause bleeding and disulfiram-like reactions due to their side chain. Cefotaxime, lacking this side chain, demonstrates a superior safety profile with minimal side effects, making it ideal for critically ill patients.

    Area of Science:

    • Pharmacology
    • Infectious Diseases
    • Clinical Medicine

    Background:

    • Beta-lactam antimicrobial agents have historically been considered safe and reliable.
    • Emerging concerns exist regarding newer beta-lactam drugs, specifically those with a methyltetrazolethiol side chain.
    • Latamoxef (moxalactam) and cefoperazone have been linked to coagulation abnormalities, bleeding, and disulfiram-like reactions.

    Purpose of the Study:

    • To evaluate the safety profiles of newer beta-lactam antimicrobial agents.
    • To compare the adverse effects of cefotaxime against other beta-lactams with a methyltetrazolethiol side chain.
    • To inform clinical selection of antibiotics for seriously ill patients based on safety data.

    Main Methods:

    • Review of clinical trial data and reported adverse events associated with beta-lactam antibiotics.
    • Comparative analysis of side effect profiles, focusing on coagulation abnormalities, bleeding, disulfiram-like reactions, and diarrhea.
    • Identification of specific structural components (methyltetrazolethiol side chain) linked to adverse events.

    Main Results:

    • Latamoxef and cefoperazone, possessing the methyltetrazolethiol side chain, are associated with significant coagulation issues, bleeding, and disulfiram-like reactions.
    • Cefotaxime, which lacks the methyltetrazolethiol side chain, did not demonstrate these adverse effects.
    • Diarrhea, a common side effect of cefoperazone, occurred in only 1% of patients receiving cefotaxime, and was typically mild.

    Conclusions:

    • The methyltetrazolethiol side chain in certain beta-lactam antibiotics is a key factor contributing to serious adverse events.
    • Cefotaxime exhibits a significantly better safety profile compared to latamoxef and cefoperazone.
    • Cefotaxime's safety record makes it a preferred choice for empirical antimicrobial therapy in critically ill patients.

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