Cephalosporin Pharmacology – Mnemonics

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
Ceph-a-lexinCef-a-zolinCef-a-clor (exception)CefuroximeCefixi-meCefotaxi-meCefi-pi-meCefta-ro-line
Cef-a-droxilCefuroxi-me axetil (exception)CefotetanCefpodoxi-me axetilCeftizoxi-meCefi-pi-romeCeftobip-ro-le

Mnemonic for Oral and Parenteral Cephalosporins


  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

cephalosporin mnemonics

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: 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
  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

H. Summary mnemonics for generation of cephalosporins:

  • First Generation = “FA/PHA”
  • Second Generation = “Everything Else”
  • Third Generation = “ONE/TEN/IME”
  • Fourth Generation = “PI” and “QUI”
  • Fifth Generation = “ROL”

34 Viewpoints 💬 on “Cephalosporin Pharmacology – Mnemonics”

  1. 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 …

  2. 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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