Cephalosporins

Cephalosporins

PRESENTATION

By: Arianna, Alex, and Courtney

Mechanism of Action:

Cephalosporins contain a beta lactam (which is a chemical structure found in large group antibiotics that help to break down bacterial cell walls) and dihydrothiazide, another structure that is found only in cephalosporins. They inhibit bacterial cell wall synthesis, leading breakdown and eventualy cell death.

Therapeutic Uses:

First generation Cephalosporins are best to fight off gram-positive bacteria. They do very little for gram negative bacteria. Because of this they are used mostly for skin or soft tissue infections, though they are not the first choice. Second generation are best for gram positive infections. They are used mostly for respiratory infections. Third generation are more broad spectrum antibiotics and are mainly used for meningitis, pneumonia and sepsis.

Adverse Effects:

The most common adverse reaction with cephalosporins is hypersensitivity. This can show up as a rash, itching, or hives, but in more serious cases it could lead to swelling of the lips, difficulty breathing, or wheezing. Provider should be notified right away if any of these adverse reactions appear.

Gastrointestinal effects like nausea, vomiting, or diarrhea can happen, and C. diff infection is a major concern since antibiotics can throw off normal gut bacteria. C-diff presents as watery diarrhea with a strong odor if this develops.

Kidney effects are another issue, especially if the patient already has kidney problems. Labs might show rising BUN and creatinine, and the patient might show signs like decreased urine output.

Extended use can lead to fungal overgrowth or secondary infections. This can occur in the mouth- thrush- or in the vaginal area.

Key Medications:

Ceftriaxone (Third-Generation) • IM or IV use • Broad-spectrum • Has a half life of 6-9 hours • Dual elimination o Eliminated through kidneys and liver excretion

Cefepime (Fourth-Generation) • IM or IV use • Can be used for both Gram-positive and Gram-negative bacteria • Used for severe infections like pneumonia

Cephalexin (First-Generation) • Can be taken orally • Effective against Gram-positive bacteria • Used to treat skin infections such as Staphylococcus and Streptococcus species

Nursing Considerations:

It’s also important to monitor kidney function, since many cephalosporins are cleared through the kidneys. Labs like BUN and creatinine, especially in older adults or anyone with pre-existing kidney problems should be monitored. Adjusting the dose may be necessary to avoid toxicity.

Another thing to pay attention to is gastrointestinal effects. Patients might experience diarrhea or upset stomach. There’s also a risk for C. diff infections because antibiotics can wipe out normal gut flora. Instruct the patient to report persistent diarrhea.

When giving cephalosporins, a nursing priority is watching for allergic reactions. Because these medications are similar to penicillins, it is important to ask if the patient has ever reacted to either drug in the past. Some patients can show cross-sensitivity, therefore any history of swelling, itching, or breathing issues needs to be taken seriously.

Case Study:

Nursing Interventions: • Assess for allergies • Verify dose • Monitor IV site o Pain o Redness o Swelling • Assess for diarrhea, abdominal cramping, fever, blood or mucus in stool • Monitor renal function

Patient Case: Patient presents to the clinic with worsening cough, fever, and thick yellow-green sputum for 3 days. Patient reports fatigue, SOB, and burning sensation in their chest with coughing. Crackles are heard in the left and right lower lobes. Chest x-ray shows bacterial pneumonia. Provider prescribes cefepime

Expected Outcome: • Symptoms improve o Improvement of symptoms within the first few days of treatment • Lab values within normal range

In what situations might a provider choose a first generation cephalosporin, and what nursing assessments are most important before giving the first dose?

First-generation cephalosporins, like cefazolin or cephalexin, are often chosen for skin infections because they are effective against gram-positve bacteria. (staphylococccus and streptococcus) Before giving the first dose, its really important to assess the patient for any history of allerigies, especially to penicillin. Check baseline renal function, because these drugs are primarly excreted through the kidneys. Last, review any current medications to avoid interactions.