What second-generation cephalosporins (2nd gen cephs) are available in a liquid formulation?

From the Guidelines

Cefuroxime axetil and cefprozil are the second-generation cephalosporins available in liquid formulation, making them suitable options for patients who require a liquid antibiotic, particularly pediatric patients or those with difficulty swallowing tablets. These medications are available as suspensions, with cefuroxime axetil coming in 125 mg/5 mL or 250 mg/5 mL concentrations, and cefprozil available in 125 mg/5 mL or 250 mg/5 mL concentrations 1. Some key points to consider when prescribing these liquid formulations include:

• They should be refrigerated after reconstitution to maintain stability
• The suspensions should be shaken well before each use
• They typically remain stable for 14 days when refrigerated
• The taste of these medications can be somewhat bitter, which may impact adherence, especially in young children Second-generation cephalosporins like cefuroxime axetil and cefprozil offer enhanced activity against gram-negative organisms, such as H influenzae and M catarrhalis, while maintaining good coverage against gram-positive organisms, making them effective for treating various infections, including respiratory tract infections, otitis media, sinusitis, and skin/soft tissue infections 1.

From the FDA Drug Label

Cefaclor for Oral Suspension, USP 20 mg/kg/day Weight125 mg/5 mL250 mg/5 mL 9 kg1/2 tsp t.i.d. 18 kg1 tsp t.i.d.1/2 tsp t.i.d. Cefprozil For Oral Suspension, USP 125 mg/5 mL is available as follows: 100 mL Bottle NDC 68180-401-03 Cefprozil For Oral Suspension, USP 250 mg/5 mL is available as follows: 50 mL Bottle NDC 68180-402-01

The second-generation cephalosporins available in a liquid formulation are:

• Cefaclor for Oral Suspension, USP 2
• Cefprozil for Oral Suspension, USP 3

From the Research

Second-Generation Cephalosporins in Liquid Formulation

• Cefprozil is available in a liquid formulation, as it is an orally active cephalosporin 4.
• Cefaclor is also available in a liquid formulation, as it is used in the treatment of various infections, including upper and lower respiratory tract infections, skin and skin-structure infections, and otitis media in children 4, 5.
• Cefuroxime axetil is available in a liquid formulation, as it is used in the treatment of mild-to-moderate infections, including respiratory tract infections and skin and skin-structure infections 6, 5.

Characteristics of Liquid Formulations

• The liquid formulations of these second-generation cephalosporins have been shown to be effective in the treatment of various infections, with a convenient administration regimen 4, 5.
• The pharmacokinetic characteristics of these liquid formulations are superior to those of earlier cephalosporins, with smaller doses and longer dosing intervals possible 6.
• However, the mean free serum concentrations of these liquid formulations may be lower than those of older cephalosporins, and their efficacy may be comparable to that of amoxicillin-clavulanate 5.