Cephalosporins

Cephalosporins

Drug monograph · NCLEX study reference
Therapeutic class	Antibacterial
Pharmacologic class	Beta-lactam (cephalosporins)
Onset / peak / duration	Rapid; dosing interval varies (ceftriaxone often once daily).
Half-life / level	Mostly short except ceftriaxone (longer); no routine level.
Routes	PO (oral), IV, IM
High-alert (ISMP)	No
Black box warning	None
Antidote / reversal	Epinephrine and supportive care for anaphylaxis.
Pregnancy / lactation	Generally considered safe.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Cephalosporins — Antibacterial; Beta-lactam (cephalosporins).

Identification

• Therapeutic class: Antibacterial.
• Pharmacologic class: Beta-lactam (cephalosporins).

Pharmacology

• Mechanism of action: Inhibit cell wall synthesis (bactericidal); higher generations gain gram-negative coverage.
• Onset / peak / duration: Rapid; dosing interval varies (ceftriaxone often once daily).
• Half-life / therapeutic level: Mostly short except ceftriaxone (longer); no routine level.

Clinical use

• Indications: Skin, respiratory, urinary infections (cephalexin), surgical prophylaxis (cefazolin), gonorrhea and serious infections (ceftriaxone), hospital and pseudomonal infections (cefepime, ceftazidime).
• Usual dose, route, frequency: Cephalexin PO; ceftriaxone IV or IM once or twice daily; cefepime IV every 8 to 12 hours.
• Maximum dose / adjustments: Reduce in renal impairment (cefepime neurotoxicity risk if not adjusted); ceftriaxone caution in neonates.

Safety

• Contraindications: Cephalosporin hypersensitivity; ceftriaxone with calcium-containing IV in neonates; severe penicillin allergy (cross-reactivity, low but present).
• Black box warning: None.
• Interactions: Probenecid, warfarin, alcohol (disulfiram-like reaction with some, food/drink), nephrotoxic drugs.
• Pregnancy / lactation: Generally considered safe.
• High-alert: No.

Adverse effects

• Common side effects: Diarrhea, rash, GI upset.
• Serious effects to report: Anaphylaxis, C. difficile colitis, cefepime neurotoxicity (confusion, seizures), severe rash.
• Antidote / reversal: Epinephrine and supportive care for anaphylaxis.

Nursing process

• Assessment before administration: Allergy history (including penicillin), cultures, renal function.
• Interventions during therapy: Do not mix ceftriaxone with calcium-containing solutions in neonates; observe for reaction.
• Monitor: Allergy signs, renal function, neuro status (cefepime), infection resolution.
• Evaluation / expected outcome: Resolution of infection.

Patient teaching

• Patient teaching: Finish the course; avoid alcohol with certain cephalosporins; report rash.
• Notify provider if: Rash or hives, breathing difficulty, severe diarrhea, confusion.
• Administration tips: Take oral forms on schedule; cefdinir absorption reduced by iron and antacids (separate by 2 hours).