Some Clinical Uses of Third- and Fourth-Generation Cephalosporins

Third- and fourth-generation cephalosporins

Polymicrobial infections involving gram-negative bacilli and gram-positive cocci (eg, intra-abdominal sepsis, decubitus ulcers, diabetic foot infections)

When necessary, used with other antibiotics to cover anaerobes or enterococci

Ceftriaxone and some other third-generation cephalosporins

Community-acquired bacterial pneumonia

Used with a macrolide or fluoroquinolone to cover atypical pathogens (mycoplasmas, Chlamydophila species, Legionella species)

Cefotaxime

Ceftriaxone

Acute meningitis suspected to be due to Streptococcus pneumoniae, Haemophilus influenzae, or Neisseria meningitidis

Used with ampicillin to coverListeria monocytogenesand with vancomycin to coverS. pneumoniae with reduced penicillin sensitivity (pending minimum inhibitory concentration results*)

Cefpodoxime (oral)

Uncomplicated skin and soft-tissue infections due to staphylococci or streptococci

Not used if methicillin-resistant Staphylococcus aureus is suspected

Ceftazidime, cefepime

Hospital-acquired pneumonia and ventilator-associated pneumonia

Empiric therapy for postneurosurgical meningitis to cover Pseudomonas aeruginosa

Used with vancomycin to cover methicillin-resistantS. aureus

Ceftriaxone

Endocarditis caused by HACEK organisms

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Endocarditis due to penicillin-sensitive streptococci

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Lyme disease with neurologic complications (except isolated Bell palsy), carditis, or arthritis

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Uncomplicated gonococcal infections, chancroid, or both

Oral doxycycline added when coinfection with chlamydia has not been excluded