Use of third-generation cephalosporins. Anaerobes

Abstract

The third-generation cephalosporins have an increased spectrum of activity against gram-negative bacteria, moderate activity against anaerobic bacteria, and reduced anti-gram-positive activity as compared with earlier cephalosporins. This spectrum allows the drugs to be considered as monotherapy for the treatment of mixed aerobic-anaerobic infections and as prophylaxis in patients in whom such mixed flora are expected. In vitro testing of anaerobes with the third-generation cephalosporins shows susceptibility to be method dependent, with regional differences also observed. The microtube broth dilution method shows the best relationship to in vivo results. Moreover, the apparent in vitro susceptibility or resistance does not always correlate with clinical efficacy. Clinical studies indicate that the expanded-spectrum third-generation cephalosporins may be used in place of combination therapy in patients with polymicrobial infection or as prophylaxis when mixed microflora are expected.