First generation cephalosporins
Second generation cephalosporins
Third generation cephalosporins
Fourth generation cephalosporins
Fifth generation cephalosporins
Veterinary cephalosporins


Cephalosporins generally exhibit a somewhat broader spectrum than penicillins, though they lack activity against enterococci. They are mostly stable to staphylococcal b-lactamases and lack cross-allergenicity with penicillins. Table 1. list the several generations of cephalosporins.

The original cephalosporin, cephalosporin C, was never marketed, but has given rise to a large family of compounds that is continuing to grow. Modifications at positions 3 and 7 of the molecule profoundly affect antibacterial activity but, as in general, substituents at the C-3 position have more influence on pharmacokinetic properties. Certain cephalosporins such as cefalotin and cefotaxime have an acetoxymethyl side chain at C-3 which is slowly altered by liver enzymes. The altered cephalosporin is usually less active than the parent antibiotic and may display altered pharmacokinetic behaviour, but there is little evidence that the clinical effectiveness is impaired. Several cephalosporins, including cefamandole, cefotetan, cefmenoxime, cefoperazone, and the oxa-cephem latamoxef possess a complex side-chain at the C-3 position that has been implicated in haematological side effects in some patients.

Table 1. Classification of cephalosporins

First generation Second generation Third generation Fourth generation Not yet classified
Cefacetrile Cefaclor Cefcapene Cefepime Cefaclomezine
Cefadroxil Cefamandole Cefdaloxime Cefozopran Cefaloram
Cefalexin Cefbuperazone Cefdinir Cefpirome Cefaparole
Cefaloglycin Cefmetazole Cefditoren Cefquinome Cefcanel
Cefalonium Cefminox Cefetamet   Cefedroler
Cefaloridine Cefonicid Cefixime   Cefempidone
 Cefalotin Ceforanide Cefmenoxime Fifth generation Cefetrizole
Cefapirin Cefotetan Cefodizime Ceftaroline fosamil Ceftiviril
Cefatrizine Cefotiam Cefoperazone Ceftobiprole Cefmatilen
Cefazaflur Cefoxitin Cefotaxime   Cefmepidium
Cefazedone Cefprozil Cefpimizole   Cefovecin
Cefazolin Cefuroxime Cefpiramide   Cefoxazole
Cefradine Cefuzonam Cefpodoxime   Cefrotil
Cefroxadine Cephamycin Cefsulodin   Cefsumide
Ceftezole   Cefteram   Ceftioxide
    Ceftazidime   Cefuracetime

The earliest cephalosporins, cefalotin and cefaloridine, are not orally absorbed. Moreover, the Gram-negative organisms are capable of elaborating a wide variety of enzymes that exhibit potent cephalosporinase activity. Developments within the cephalosporin family were aimed at obtaining compounds with improved properties: oral absorption, wider spectrum of action, stability to inactivating enzymes, improved pharmacokinetic profile or a combination of these features.


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