Selection of cephalosporins for hospital formularies

Because of the large number of cephalosporins available for use, and for economic reasons, most hospitals have restricted the number of cephalosporins for inclusion on hospital formularies. No more than one first-generation oral and parenteral cephalosporin is necessary. The second- and third-generation oral cephalosporins are more active in vitro against Haemophilus influenzae and Enterobacteriaceae, and the selection of one of these drugs should be based primarily on acquisition cost. There is usually minimal, if any, need for a second-generation parenteral cephalosporin on hospital formularies. The choice of a single third-generation parenteral cephalosporin should be made primarily on the cost of equivalent daily dosages. A single antipseudomonal cephalosporin should be included in the hospital formulary, and the selection should be based on cost and availability.