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[The third generation cephems for surgical infections].

K Ishibiki, N Aikawa

    Nihon Geka Gakkai Zasshi
    |September 1, 1984
    PubMed
    Summary
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    Third-generation cephalosporins (cephems) show excellent activity against Gram-negative pathogens but lower efficacy against Gram-positive bacteria. Clinical use should focus on Gram-negative surgical infections in immunocompromised patients to prevent resistance.

    Area of Science:

    • Pharmacology
    • Microbiology
    • Clinical Medicine

    Context:

    • Third-generation cephalosporins, including Cefotaxime, Ceftizoxime, Cefmenoxime, and Latamoxef, were developed for opportunistic Gram-negative pathogens and surgical infections.
    • These antibiotics exhibit potent in vitro activity against Enterobacter spp., indole-positive Proteus spp., Pseudomonas spp., and Bacteroides spp.

    Purpose:

    • To evaluate the efficacy and pharmacokinetic properties of third-generation cephalosporins in surgical infections.
    • To compare their clinical performance against second-generation cephalosporins.

    Summary:

    • Third-generation cephalosporins possess longer serum half-lives, reduced urinary excretion, and higher biliary transmission without metabolic inactivation.
    • Clinical trials in Japan demonstrated an average efficacy rate of 84% for surgical infections.

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  • A discrepancy exists between their broad-spectrum activity and clinical results, with Gram-negative infections not showing superior response rates compared to Gram-positive infections.

    • Impact:

    • Clinical application should be judiciously limited to Gram-negative surgical infections in immunocompromised hosts.
    • This targeted approach aims to mitigate the emergence of antibiotic-resistant strains.
    • Findings suggest a need for careful consideration of the antibacterial spectrum versus clinical outcomes in treatment strategies.