Cephalosporins and related antibiotics: an overview

With the release of cefotaxime and, more recently, moxalactam, there are now 13 cephalosporin drugs available in the United States, and close to another half dozen are under investigation. Commercial competition is steep, and every new product is being praised as superior to its predecessor. In general, it is necessary to become familiar with one formulation that can be given parenterally and one that is available for oral use. For certain patients, primarily those with nosocomial infections, one of the extended-spectrum cephalosporins must be considered, but these drugs should be employed only when specifically indicated. Certainly, cefotaxime has good stability to many beta-lactamases and possesses a wider spectrum of activity against gram-negative bacilli than any other clinically available cephalosporin. Clinical trials have demonstrated the efficacy of cefotaxime in diverse infections, including those associated with E. coli, indole-positive and indole-negative species of Proteus, and species of Klebsiella and Serratia. Strains of Enterobacter species, P. aeruginosa, and B. fragilis are only moderately susceptible to cefotaxime, and enterococci are frequently resistant. Although the antibacterial activity and wide spectrum of cefotaxime, coupled with its apparent safety and tolerability, make it a useful antibiotic for the treatment of serious nosocomial infections, it will frequently have to be employed with another agent--i.e., an aminoglycoside--until the precise identification and in vitro susceptibility of the infecting organism is known.