Clinical Case about Second Generation Cephalosporins:  Gap-Fill Exercise


Fill in all the gaps, then press "Check" to check your answers.
  • Medical Setting:

    • Patient is a four year-old girl; no significant past medical history; no siblings; up-to-date vaccinations

  • Primary complaint & History:

    • You are called by the patient's mother at 3 a.m. explaining that her daughter is awake, vomiting with a fever, a washed-out appearance and a complaint of year pain. You learn that the child's nasal discharge was clear two days ago, but has been green for the last 24 hours. You suggest that the mother give her daughter acetaminophen (Tylenol,-- elixir or suppository) and bring her to your office at 9 a.m.

  • Physical Exam:

    • Pale, for year-old girl having difficulty following commands
      Temperature: 39; BP 70/40; pulse 140.  Pharynx-normal; tympanic membranes-right, inflamed; left, normal Abdomen-soft, non-tender; Neck-supple



   anaerobes      enterococci      gram-negative      H. influenzae      less      otitis      peritonitis      Pseudomonas aeruginosa      sinusitis   
Second generation cephalosporins include: cefaclor, cefamandol, cefonicid, cefuroxime, cefprozil, loracarbef, and ceforanide and structurally related agents: cefoxitin, cefmetazole, and cefotetan. These drugs have, in addition to the spectrum of action of first generation compounds, have extended coverage to organisms. Second generation agents are active against gram-positive bacteria than first-generation drugs.

Second generation drugs are not active against or .

Oral second-generation cephalosporins are active against beta-lactamase-producing or Branhamella catarrhalis. These drugs are used primarily to treat , or lower respiratory tract infections caused by these organisms (H. influenzae or Branhamella catarrhalis).

Some second generation drugs, cefoxitin, cefotetan, and cefmetazole, have activity against (including B. fragilis) and may be used in mixed anaerobic infections such as or diverticulitis.
Cefuroxime: effective in treating community-acquired pneumonia (particularly if pneumonia may be caused by beta-lactamase-producing H. influenzae or Klebsiella pneumoniae.