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.
Classification of Cephalosporins
| 1st Generation | 2nd Generation | 3rd Generation | 4th Generation | 5th Generation | |||
| Oral | Parenteral | Oral | Parenteral | Oral | Parenteral | Parenteral | Parenteral |
| Ceph-a-lexin | Cef-a-zolin | Cef-a-clor (exception) | Cefuroxime | Cefixi-me | Cefotaxi-me | Cefi-pi-me | Cefta-ro-line |
| Cef-a-droxil | Cefuroxi-me axetil (exception) | Cefotetan | Cefpodoxi-me axetil | Ceftizoxi-me | Cefi-pi-rome | Ceftobip-ro-le | |
| Ceph-a-ridine | Loracarbef | Cefoxitin | Ceftibuten | Ceftriaxone | Cef-qui-nome | Cefto-lo-zane | |
| Cefprozil | Cefmetazole | Cefditoren | Ceftazidi-me | ||||
| Cefdinir | Cefoperazone | ||||||
| Moxalactam | |||||||
Mnemonic for Oral and Parenteral Cephalosporins
Parenteral:
- All 4th and 5th generation cephalosporins
- Have “t” except ceftibuten and cefditoren
- Having “z” – zone, zolin, zole
Oral:ย Have “OR” in the name – Cefaclor, Cefditoren, Loracarbef
Menmonic to remember classification by generation of Cephalosporins
A. 5th generation:
- With “ro” and “lo”: ceftobiprole, ceftaroline, ceftolozane
B. 4th generation:
- With “pi” and “qui”: Cefepime, Cefepirome, Cefquinome
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:ย Disrupt cell wall synthesis by inhibiting transpeptidase (cross-linking)
C. Pharmacokinetics:
- Most are excreted by kideny (tubular secretion).
- 2 “Zones” are secreted in bile: Ceftriaxone and Cefoperazone
D. Blood brain barrier (BBB) penetration:
- 1st generation: No BBB penetration
- 2nd generation: Cefuroxime has highest among 2nd generation
- 3rd generation: Except Cefoperazone and Cefixime
E. Spectrum of activity:
| Generation | Gram Negatives | Gram Positives | ฮฒ-Lactamase Stability |
|---|---|---|---|
| 1st | + | +++ | +/- |
| 2nd | ++ | ++ | + |
| 3rd | +++ | + | ++ |
| 4th | +++ | ++ | +++ |
| 5th | +++ | +++ | ++++ |
- 1st generation: Mainly Gram+
Gram – (PEcK): Proteus, E.Coli, Klebsiella
- 2nd generation: Gram- > Gram+
HEN PEcKS: Haemophilus influenzae,ย Enterobacter,ย Neissera,ย Proteus,ย E. Coli,ย Klebsiella,ย Serratia
- 3rd generation: Gram – >> Gram +
Ceftriaxone: Meningitis, Gonorrhea
Ceftazidime and Cefoperazone: Pseudomonas
Used to treat meningitis and sepsis (can cross Blood Brain Barrier) - 4th generation: Pseudomonas
- 5th generation: MRSA
Activity against Bacteroides:
- 2nd generation:ย Cefoxitin, Cefotetan and Cefmetazole
- 3rd generation: Ceftizoxime (maximum)
Activity agaisnt pseudomonas:
- Ceftazidime (maximum)
- Ceftazolone
- Cefoperazone
Cephalosporins don’t have activity against: “LAME”
- Listeria
- Atypicals (includingย Mycoplasmaย andย Chlamydia)
- MRSA (Except 5th generation)
- Enterococci
F. Drug of choice:
- Surgical prophylaxis: Cefazolin
- Melioidiosis (Burkholderia psudomalleri): Ceftazidime
- Gonorrhea, salmonellosis (including typhoid), E. coli sepsis, Proteus, Serratia, Haemophilus and empirical therapy for bacterial
meningitis: Ceftriaxone - Pseudomonal CNS infection: Ceftazidime or Cefepime or Meropenem (For GU and GI infections – Fluoroquinolones and Aminoglycosides)
- Bacteroides: Metronidazole (Cefoxitin is an alternative along with clindamycin and chloramphenicol)
G. Adverse effects:
- Drugs with methylthiotetrazole group: Cefamandole, Cefoperazone, Cefotetan, Moxalactam
- Acts like oral anticoagulant (Vit. K antagonist): Bleeding (hypoporthrombinemia)
- Disulfiram like reaction
- Biliary sludging:
- Ceftriaxone
- Cefotaxime
- Taste disutrbance: Ceftobiprole
- Non-bloody red stools: Cefdinir
- Nephrotoxicity:
- Cephaloridine (highest nephrotoxicity)
- Cephalothin
- Neutropenia: Ceftazidime
- Thrombophlebitis (Parenteral)
- Diarrhea
- Anaphylaxis
Mnemonic:ย “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
H. Summary mnemonics for generation of cephalosporins:
- First Generation = โFA/PHAโ
- Second Generation = โEverything Elseโ
- Third Generation = โONE/TEN/IMEโ
- Fourth Generation = โPIโ and “QUI”
- Fifth Generation = โROLโ
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.
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