Mnemonics to remember Pharmacology of Cephalosporins

Cephalosporins are one of the most widely prescribed antimicrobial drugs. They can be classified into 5 to generations and the medical students often have hard time remembering the names of drugs falling into different generations as the names appear and sound similar. This is a collection of mnemonics from different sources.

Cephalosporin confusing

Classification of Cephalosporins

1st Generation2nd Generation3rd Generation4th Generation5th Generation
OralParenteralOralParenteralOralParenteralParenteralParenteral
Ceph-a-lexinCef-a-zolinCef-a-clor (exception)CefuroximeCefixi-meCefotaxi-meCefi-pi-meCefta-ro-line
Cef-a-droxil Cefuroxi-me axetil (exception)CefotetanCefpodoxi-me axetilCeftizoxi-meCefi-pi-romeCeftobip-ro-le
Ceph-a-ridine LoracarbefCefoxitinCeftibutenCeftriaxone  
  CefprozilCefmetazoleCefditorenCeftazidi-me  
    CefdinirCefoperazone  
     Moxalactam 

Mnemonic for Oral and Parenteral Cephalosporins

Parenteral:

  1. All 4th and 5th generation cephalosporins
  2. Have “t” except ceftibuten and cefditoren
  3. Having “z” – zone, zolin, zole

Oral: Have “OR” in the name – Cefaclor, Cefditoren, Loracarbef

cephalosporins

Menmonic to remember classification by generation of Cephalosporins

A. 5th generation:

  • With “ro”: ceftobiprole, ceftaroline

B. 4th generation:

  • With “pi”: Cefepime, Cefepirome

C. 1st generation:

All cephalosporins having “A” after “Cef” are 1st generation except Cefaclor.

2 Xs and 1 Z in Dine

  • 2 “X” – cefalexin, cefadroxil
  • 1 “Z” – cefazolin
  • 2 “IN” – cefalothin, cefaparin
  • DINE – cephradine

D. 3rd generation:

Cephalosporins ending with “me” are 3rd generation except cefuroxime.

“cef” +/- (a,e,i,o,u) + p/d/t

  • cefotaxime, ceftizoxime, ceftriaxone, ceftazidime, cefoperazone
  • cefixime, cefpodoxime, cefdinir, ceftibuten, ceftamet

E. 2nd generation:

FURy FOX FOR FON TEA and 2 Ms for a Macho fox

  • ceFURoxime, ceFOXitine, ceFORanide, ceFONicid, cefoTEtan
  • cefMandole, cefMetazole
  • Remember one more drug: Cefaclor

Flomoxef has been classified by different authors into different generations – 2nd, 3rd and 4th generations.

Short review of pharmacology of cephalosporins

A. Class: Beta-lactams (like Penicillin)

B. Mechanism of action: Disrupt cell wall synthesis by inhibiting transpeptidase (cross-linking)

C. Pharmacokinetics:

  1. Most are excreted by kideny (tubular secretion).
  2. 2 “Zones” are secreted in bile: Ceftriaxone and Cefoperazone

D. Blood brain barrier (BBB) penetration:

  1. 1st generation: No BBB penetration
  2. 2nd generation: Cefuroxime has highest among 2nd generation
  3. 3rd generation: Except Cefoperazone and Cefixime

E. Spectrum of activity:

GenerationGram NegativesGram Positivesβ-Lactamase Stability
1st+++++/-
2nd+++++
3rd++++++
4th++++++++
5th++++++++++
  1. 1st generation: Mainly Gram+

    Gram – (PEcK): Proteus, E.Coli, Klebsiella

  2. 2nd generation: Gram- > Gram+

    HEN PEcKS: Haemophilus influenzae, Enterobacter, Neissera, Proteus, E. Coli, Klebsiella, Serratia

  3. 3rd generation: Gram – >> Gram +

    Ceftriaxone: Meningitis, Gonorrhea
    Ceftazidime and Cefoperazone: Pseudomonas
    Used to treat meningitis and sepsis (can cross Blood Brain Barrier)

  4. 4th generation: Pseudomonas
  5. 5th generation: MRSA

Activity against Bacteroides:

  • 2nd generation: Cefoxitin, Cefotetan and Cefmetazole
  • 3rd generation: Ceftizoxime (maximum)

Activity agaisnt pseudomonas:

  • Ceftazidime (maximum)
  • Ceftazolone
  • Cefoperazone

Cephalosporins don’t have activity against: “LAME”

  • Listeria
  • Atypicals (including Mycoplasma and Chlamydia)
  • MRSA (Except 5th generation)
  • Enterococci

F. Drug of choice:

  1. Surgical prophylaxis: Cefazolin
  2. Melioidiosis (Burkholderia psudomalleri): Ceftazidime
  3. Gonorrhea, salmonellosis (including typhoid), E. coli sepsis, Proteus, Serratia, Haemophilus and empirical therapy for bacterial
    meningitis: Ceftriaxone
  4. Pseudomonal CNS infection: Ceftazidime or Cefepime or Meropenem (For GU and GI infections – Fluoroquinolones and Aminoglycosides)
  5. Bacteroides: Metronidazole (Cefoxitin is an alternative along with clindamycin and chloramphenicol)

G. Adverse effects:

  1. Drugs with methylthiotetrazole group: Cefamandole, Cefoperazone, Cefotetan, Moxalactam
    • Acts like oral anticoagulant (Vit. K antagonist): Bleeding (hypoporthrombinemia)
    • Disulfiram like reaction
  2. Biliary sludging:
    • Ceftriaxone
    • Cefotaxime
  3. Taste disutrbance: Ceftobiprole
  4. Non-bloody red stools: Cefdinir
  5. Nephrotoxicity:
    • Cephaloridine (highest nephrotoxicity)
    • Cephalothin
  6. Neutropenia: Ceftazidime
  7. Thrombophlebitis (Parenteral)
  8. Diarrhea
  9. Anaphylaxis

Mnemonic: “DDT HAPeNS”

D – diarrhea
D – disulfiram like reaction
T – thrombophlebitis
H – hypoprothrombinemia
A – allergy (hypersensitivity)
P – pain (severe with i.m.)
N – nephrotoxicity
S – super infections with fungi

28 thoughts on “Mnemonics to remember Pharmacology of Cephalosporins

  1. Thank you sooo much… It saved my time and helped me to quickly learn them without mess… Thanks… 🙂

  2. Still hard for me to remember all, tried my best but only 1st and 2nd generation stick in my mind…all in all thanks for your help …

  3. Thank you. Just a note in terms of third gen mnemonic. It says all drugs ending in -me are third generation except cefuroxime. I just wanted to add cefepime to that except also, which is fourth gen

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