What are the different oral cephalosporins (antibiotics)?

From the Guidelines

Oral cephalosporins are a class of antibiotics that include first, second, third, and limited fourth-generation options, with the most recent evidence suggesting that cefdinir, cefixime, and cefpodoxime are effective against many gram-positive and some gram-negative bacteria 1.

Key Points

• First-generation oral cephalosporins include cephalexin (Keflex), cefadroxil (Duricef), and cefazolin.
• Second-generation options include cefaclor, cefuroxime axetil (Ceftin), cefprozil (Cefzil), and cefpodoxime proxetil (Vantin).
• Third-generation oral cephalosporins include cefdinir (Omnicef), cefixime (Suprax), and ceftibuten (Cedax).
• The only fourth-generation oral cephalosporin is cefixime.
• These medications work by inhibiting bacterial cell wall synthesis and are effective against many gram-positive and some gram-negative bacteria.
• Dosing varies by specific agent, infection type, and patient factors like age and kidney function.
• First-generation cephalosporins are particularly effective against gram-positive organisms, while later generations have improved gram-negative coverage but may lose some gram-positive efficacy.
• Common side effects include gastrointestinal disturbances, allergic reactions (especially in penicillin-allergic patients with a low cross-reactivity risk) 1, and potential for Clostridioides difficile infection.
• These antibiotics are commonly used for respiratory, urinary tract, skin, and soft tissue infections depending on the specific agent's spectrum of activity.

Evidence-Based Recommendations

• The most recent evidence suggests that the cross-reactivity between penicillins and cephalosporins is lower than historically reported, with a rate of around 2% 1.
• Cefdinir, cefixime, and cefpodoxime are effective against many gram-positive and some gram-negative bacteria, making them suitable options for various infections 1.
• The choice of oral cephalosporin should be based on the specific infection, patient factors, and local resistance patterns.

From the FDA Drug Label

Cefixime is a semisynthetic, cephalosporin antibacterial for oral administration. Cephalexin, USP is a semisynthetic cephalosporin antibiotic intended for oral administration. Cefadroxil monohydrate is a semisynthetic cephalosporin antibiotic intended for oral administration.

The oral cephalosporins mentioned are:

• Cefixime 2
• Cephalexin 3
• Cefadroxil 4

From the Research

Oral Cephalosporins

The following are some of the oral cephalosporins mentioned in the studies:

• Cefadroxil 5, 6
• Cephalexin 7, 5, 6, 8
• Cefaclor 9, 7, 8
• Cefprozil 9, 8
• Loracarbef 9
• Cefatrizine 7
• Cefuroxime axetil 7, 8
• Cefdinir 8
• Cefpodoxime 8

Classification of Oral Cephalosporins

Oral cephalosporins can be classified into different generations, including:

• First-generation oral cephalosporins: cefadroxil, cephalexin, cefaclor 9, 6
• Second-generation oral cephalosporins: cefaclor, cefatrizine, cefuroxime axetil 9, 7
• Third-generation oral cephalosporins: cefdinir, cefpodoxime, cefprozil 9, 8

Uses of Oral Cephalosporins

Oral cephalosporins are used to treat various infections, including:

• ENT infections 9
• UTIs 9, 6
• STDs 9
• Lower respiratory tract infections 9, 8
• Skin and soft tissue infections 9, 5, 8