![]() ![]() , It has been estimated that 55% of all antibiotic prescriptions may be unnecessary. Several studies show a disturbing trend toward increasing use of broad-spectrum antibiotics. Broad-spectrum agents, such as piperacillin-tazobactam (Zosyn) and vancomycin, are commonly used for empirical antibiotic coverage in suspected early sepsis and critically ill patients. Suspected sepsis is one of the most common causes of ED evaluation and hospital admission. Which antibiotic regimen should be administered?Įmergency Physicians are faced with the dilemma of antibiotic selection in patients with presumed sepsis or serious bacterial infection. After initial stabilization, he is taken to the operating room for emergency laparotomy for suspected peritonitis secondary to perforated appendicitis. His vital signs include temperature 102 F, heart rate 132 beats/minute, respiratory rate 36 breaths/minute, blood pressure 80/50 mm Hg, and oxygen saturation 91%. Georges University Grenada West Indies 3) // Edited by: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD Case:Ī 65-year-old man is brought to the ED in shock. High yield EZmed content on Instagram: animations and videos on YouTube: EZmedĮZmed Illustrations and flashcards on Pinterest: ezmedlearningįeel free to use the contact button to reach out with any feedback or suggestions you may have for future topics.Authors: Mariam Abdelghany, PA-C 1, Minela Subasic, PA-C 1, Anthony Scoccimarro, MD 1, Joel Gernsheimer, MD 2, and Muhammad Waseem, MD, MS 1,3 (Lincoln Medical & Mental Health Center Bronx, New York 1 SUNY Downstate Medical Center New York 2 St. Perform well in class, ace your exams, and keep up with your medical knowledge throughout your career using: If you enjoyed the content in this post, don’t forget to join the EZmed community for free on the bottom of the page or in the navigation bar so you don’t miss out on future medical topics made easy. Use the following to help you remember the general coverage:ġst Generation: Good Gram-Positive Poor Gram-NegativeĢnd Generation: OK Gram-Positive OK Gram-Negativeģrd Generation: Poor Gram-Positive Good Gram-NegativeĤth Generation: Pseudomonas + Good gram-positive and negativeĥth Generation: MRSA + Good gram-positive and negativeīefore You Go, Make Your Learning Experience Even Easier! Hopefully the arrow trick gave you an easy way to remember cephalosporin coverage for the different generations. Some bacteria are resistant to beta-lactam antibiotics as they produce beta-lactamase, an enzyme that destroys the antibiotic beta-lactam structure.įourth generation cephalosporins can cover against beta-lactamase gram-negative organisms better than third generation medications can. Similar to ceftriaxone (third generation), cefepime can penetrate the blood-brain barrier and into cerebrospinal fluid. ![]() These are broad-spectrum antibiotics, covering both gram-positive and gram-negative organisms, typically used in sepsis and serious infections. That is why the second arrow is labeled “pseudomonas” to help you remember fourth generation drugs have coverage against this.Įxamples of fourth generation cephalosporins include cefepime and cefpirome. The main difference, however, is fourth generation cephalosporins generally cover pseudomonas as well. Other common uses for fist generation medications include urinary tract infections, respiratory infections, otitis media, orthopedic injuries, and surgical prophylaxis.įourth generation cephalosporins have a similar gram-positive and gram-negative profile as third generation cephalosporins. coli), Proteus mirabilis, and Klebsiella pneumoniae.Įxamples of first generation cephalosporins include cephalexin, cefazolin, cephalothin, cephapirin, cefadroxil, and cephradine. They have less coverage against gram-negative bacteria, but do cover Escherichia coli (E. Then as you progress down the arrow, the gram-positive coverage weakens but gram-negative coverage improves significantly.įirst generation cephalosporins have coverage against most gram-positive cocci including staphylococcus and streptococcus species.įor this reason, they are commonly used for uncomplicated skin and soft tissue infections presumed to be caused by staphylococcal (methicillin-sensitive) and streptococcal species. ![]() This is to help you remember that generally speaking the first generation cephalosporins have strong gram-positive coverage and minimal gram-negative coverage. The arrow starts off with gram-positive and ends with gram-negative. ![]()
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