Second-Generation Cephalosporins for Various Infections
Second-generation cephalosporins such as cefuroxime are recommended for respiratory tract infections, sinusitis, and moderate-severe infections with mixed flora, particularly when coverage for both gram-positive and gram-negative organisms is needed. 1
Characteristics of Second-Generation Cephalosporins
Second-generation cephalosporins offer:
- Moderate gram-positive coverage (less than first-generation)
- Improved gram-negative coverage compared to first-generation
- Some anaerobic coverage (particularly cephamycins)
- Common examples: cefuroxime, cefaclor
Specific Indications for Second-Generation Cephalosporins
Respiratory Tract Infections
- Haemophilus influenzae β-lactamase (+): Cefuroxime 1.5 g IV q8h is recommended as a preferred treatment 2
- Community-acquired pneumonia: In children over 3 years with suspected atypical bacteria, macrolides are preferred, but second-generation cephalosporins may be used when bacterial etiology is suspected 2
- Acute bronchiolitis: Amoxicillin-clavulanate, cefuroxime-axetil or cefpodoxime-proxetil are appropriate in cases of high fever (38.5°C) persisting for more than 3 days 2
Skin and Soft Tissue Infections
- Second-generation cephalosporins are recommended by the World Society of Emergency Surgery for skin and soft tissue infections 1
- Effective against Staphylococcus aureus (methicillin-susceptible only) and Streptococcus species
Urinary Tract Infections
- Useful for empiric treatment of urinary tract infections in outpatient settings 3
- Effective against common uropathogens including E. coli and other Enterobacteriaceae
Specific Second-Generation Cephalosporins
Cefaclor
- Dosage:
- Adults: 250 mg every 8 hours; can be doubled for severe infections
- Pediatric: 20 mg/kg/day in divided doses every 8 hours; can be increased to 40 mg/kg/day for more serious infections 4
- Indications: Respiratory infections, otitis media, pharyngitis
- Spectrum: Active against S. aureus (methicillin-susceptible), S. pneumoniae, S. pyogenes, E. coli, H. influenzae, Klebsiella spp., and P. mirabilis 4
Cefuroxime
- Spectrum: Active against respiratory pathogens including H. influenzae, S. pneumoniae, S. pyogenes, and M. catarrhalis 5
- Indications: Lower and upper respiratory tract infections, urinary tract infections, skin and soft tissue infections 5
- Advantages: Balanced efficacy with safety profile; recommended by international bodies including US FDA and British Thoracic Society 3
- Dosing flexibility: Extended half-life allows dosing every 8 hours 6
Important Clinical Considerations
- Second-generation cephalosporins should be used when their spectrum specifically matches the suspected pathogens rather than using broader spectrum agents 1
- Duration of therapy typically ranges from 7-14 days for most infections, with shorter durations (3-5 days) appropriate for many uncomplicated infections 1
- For β-hemolytic streptococcal infections, treatment should continue for at least 10 days 4
- Cephalosporins are generally well-tolerated but may cause gastrointestinal disturbances and hypersensitivity reactions 1
Limitations and Cautions
- Not effective against methicillin-resistant staphylococci, Pseudomonas species, Acinetobacter, Enterococcus, and most Enterobacter species 4
- β-lactamase-negative, ampicillin-resistant strains of H. influenzae should be considered resistant to cefaclor despite apparent in vitro susceptibility 4
- Dosage adjustments required in patients with renal impairment 1
- Risk of Clostridioides difficile infection should be considered 1
By selecting the appropriate second-generation cephalosporin based on the suspected pathogen and site of infection, clinicians can effectively treat a wide range of community-acquired infections while maintaining a reasonable spectrum of antimicrobial coverage.