c



   

`a 3rd generation agents include cefoperazone, cefotaxine, ceftazidime, ceftizoxime, 
 , cefixime,
cefpodoxime proxetil, cefditoren pivoxil, ceftibuten, moxalactam.

 




`a 3ajor feature : exapnded gram-negative coverage and ability to cross BBB.

`a ffective against :
-a Gram negative bacteria
-a Citrobacter, Ô


  
and providencia
-a ë lactamase producing strain of Haemophillus and Neisseria
-a Ceftazidime and cefoperazone G also active against P aeruginosa
-a unly Ceftixozime and mozalactam have good activity against B fragilis.
`a Not active against :
-a nterobacter sp. (karena nterobacter pny chromosomal ë lactamase yang dpt menghidrolisis 3rd
generation cephalosporin)
-a Serratia, providencia, and citrobacter also produce chromosomally encoded cephalosporinase that when
constitutively expressed confers resistance to 3rd generation cephalosporin.
^    

 


`a fter IV infusion of 1 gr of these drugs, serum level are : 60 -140 µg/mL.

`a Penetrate body fluids and tissues well and achieve levels in CSF sufficient to inhibit most pathogen, include gram -
negative rods, except Pseudomonas.
`a Ceftriaxone :
-a T½ : 7-8 h
-a Dosage : 15-50 mg/kg/d as a single dose.
-a  single daily 1g dose is sufficient for m ost serious infections, with 4g dose recommended for treatment of
meningitis.
Cefoperazone :
-a T½ : 2h
-a Dosage : 25-100 mg/kg/d every 8-12 hours.
Remaining drugs :
-a T½ : 1-1,7 h
-a Dosage : injected every 6-8 h in dosages between 2 and 12 g/d
Cefixime can be given orally (200 mg bid or 400 mg as single dose) for respiratory or UTI.
`a xcretion :
-a Cefoperazone and ceftriaxone mainly through billiary tract and no dosage adjustment required to renal
insufficiency.
-a uthers : via renal G require adjustment for pts with renal insufficiency.
c  


`a 3rd generation cephalosporins are used to treat a wide avriety of serious infection caused by organisms that are
resistant to most other drugs.
`a Ceftriaxone (as a single 125 mg injection) and cefixime (as a single 400 mg oral dose) are first -line drugs for
treatment of gonorrhea..
`a Because of their penetration of CNS, they can be use to treat meningitis, including meningitis caused by
pneumococci, meningococci, h influenzae, and susceptible enteric gram -negative rods, but not Listeria
monocytogenes.
`a If the meningitis is caused by P aeruginosa should be used in combination with aminoglycosides.
`a Ceftriaxone and cefotaxime are the most acctive cephalosporins against penicillin -resistant strains of
pneumococci and recommended for empirical therapy of serious infections that caused by these strains.
 ·
   

  

  
 

 
  

      

   
    
     
  
mpicillin 2ʹ3 2ʹ100

ztreonam 2 5

Cefotaxime 22.5 27ʹ36

Ceftazidime 0.7 20ʹ40

Ceftriaxone 0.8ʹ1.6 16

Cefuroxime 20 17ʹ88

Ciprofloxacin 6ʹ27 26ʹ37

Imipenem 3.1 11ʹ41

3eropenem 0ʹ7 1ʹ52

Nafcillin 2ʹ15 5ʹ27

Penicillin G 1ʹ2 8ʹ18

Sulfamethoxazole 40 12ʹ47

Trimethoprim < 41 12ʹ69

Vancomycin 0 1ʹ53
a