Key Terms aplastic anemia Stevens-Johnson epidermal necrolysis syndrome nephrotoxicity

Chapter Objectives

On completion of this chapter, the student will:

• Explain the difference between the first-, second-, and third-generation cephalosporins.

• Discuss uses, general drug action, adverse reactions, contraindications, precautions, and interactions associated with the cephalosporins.

• Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking cephalosporins.

• List some nursing diagnoses particular to a patient taking cephalosporins.

• Discuss ways to promote an optimal response to therapy, how to manage common adverse reactions, special considerations related to administration, and important points to keep in mind when educating patients about the use of the cephalosporins.

The effectiveness of penicillin in the treatment of infections prompted research directed toward finding new antibiotics with a wider range of antibacterial activity. The cephalosporins are a valuable group of drugs that are effective in the treatment of almost all of the strains of bacteria affected by the penicillins, as well as some strains of bacteria that have become resistant to penicillin. The cephalosporins are structurally and chemically related to penicillin.

The cephalosporins are divided into first-, second-, and third-generation drugs. Particular cephalosporins also may be differentiated within each group according to the microorganisms that are sensitive to them. Generally, progression from the first-generation to the second-generation and then to the third-generation drugs shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms. For example, a first-generation cephalosporin would have more use against gram-positive microorganisms than would a third-generation cephalosporin. This scheme of classification is becoming less clearly defined as newer drugs are introduced. Examples of first-, second-, and third-generation cephalosporins are listed in Display 8-1. For a more complete listing see the Summary Drug Table: Cephalosporins.

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