An Overview of Oral Third Generation Cephalosporin Antibiotics: Uses, Side Effects, Alternatives

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What Are Oral Third Generation Cephalosporins?

Oral third generation cephalosporins are a class of broad-spectrum antibiotics that are commonly prescribed to treat a variety of bacterial infections. They are considered third generation because they were developed after earlier cephalosporins and have an expanded spectrum of activity against Gram-negative bacteria like E. coli, Klebsiella pneumoniae, and Proteus mirabilis. Some of the most widely used oral third generation cephalosporins include:

Cefixime

Cefixime (Suprax) was the first oral third generation cephalosporin to be approved for clinical use. It has activity against both Gram-positive and Gram-negative bacteria. Cefixime is often prescribed to treat infections of the upper respiratory tract, urinary tract infections, gonorrhea, otitis media, and lyme disease in adult patients and children.

Cefpodoxime

Cefpodoxime (Vantin) is another common oral third generation cephalosporin. It is active against a wide spectrum of Gram-negative and Gram-positive bacteria including S. pneumoniae, S. pyogenes, and H. influenzae. Cefpodoxime is used to treat acute otitis media, sinusitis, tonsillitis, pneumonia, gonorrhea, and urinary tract infections.

Ceftibuten

Ceftibuten (Cedax) is used to treat mild-to-moderate bacterial infections including bronchitis, pharyngitis, tonsillitis, acute sinusitis, and urinary tract infections. It has good activity against Haemophilus influenzae, Moraxella catarrhalis and most strains of Streptococci.

How Do Oral Third Generation Cephalosporins Work?

Cephalosporins like cefixime, cefpodoxime, and ceftibuten work by interfering with bacterial cell wall synthesis. They bind to and inactivate penicillin-binding proteins (PBPs) which are enzymes needed for peptidoglycan crosslinking during cell wall formation. This weakens the bacterial cell wall and ultimately leads to cell lysis and death.

Third generation cephalosporins have an expanded spectrum of gram-negative coverage due to their increased ability to resist beta-lactamases. Beta-lactamases are enzymes produced by some bacteria that break down beta-lactam antibiotics like penicillins and cephalosporins.

What Conditions Are Oral Third Generation Cephalosporins Used to Treat?

Some of the most common uses and indications for oral third generation cephalosporins include:

Respiratory Tract Infections

Oral cephalosporins are often prescribed for respiratory conditions like bronchitis, pneumonia, sinusitis, pharyngitis and tonsillitis. They are effective against common culprits like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Ear Infections (Otitis Media)

Third generation cephalosporins like cefixime and cefpodoxime are first-line antibiotics for treating acute otitis media in children. They provide good coverage against S. pneumoniae, H. influenzae, and M. catarrhalis which frequently cause ear infections.

Urinary Tract Infections

Oral cephalosporins are a standard treatment for uncomplicated urinary tract infections. They are especially effective for infections caused by E. coli, Klebsiella species, and Proteus mirabilis.

Gonorrhea

Third generation cephalosporins remain a cornerstone for treating gonorrhea infections. They are often prescribed as first-line empiric therapy for gonorrhea before susceptibility results are available.

Skin Infections

Oral cephalosporins provide coverage against many common skin pathogens including Staphylococcus aureus and Streptococcus pyogenes. They can be used to treat mild-to-moderate skin and soft tissue infections.

What Are the Side Effects of Oral Third Generation Cephalosporins?

Oral third generation cephalosporins are usually well tolerated with mild side effects. However, some potential adverse reactions can include:

Nausea, vomiting, diarrhea
Abdominal pain
Headache
Dizziness
Rash
Vaginal yeast infection

More severe allergic reactions are possible in those with sensitivities to cephalosporin or penicillin antibiotics. Seek medical care immediately if you experience swelling, hives, difficulty breathing or any signs of anaphylaxis after taking a cephalosporin antibiotic.

Drug Interactions

Oral third generation cephalosporins can potentially interact with several other medications. These include:

Probenecid - can increase cephalosporin blood levels
Anticoagulants like warfarin - cephalosporins may prolong bleeding time
Allopurinol - may increase likelihood of skin rash
Oral contraceptives - effectiveness may be reduced

Be sure to let your doctor know about any other medications you are taking to avoid any significant drug interactions.

Who Should Not Take Oral Third Generation Cephalosporins?

Oral cephalosporins should not be taken by people with a history of severe allergic reactions or hypersensitivities to:

Cephalosporin antibiotics
Penicillin or other beta-lactam antibiotics

Use caution when giving cephalosporins to pregnant women and nursing mothers. Cephalosporins may cause damage to developing joints in fetuses. They are also excreted in low levels in breast milk and could cause adverse effects like diarrhea, fungus infections, and allergic reactions in nursing infants.

How Are Oral Third Generation Cephalosporins Administered?

Third generation cephalosporins are given orally, typically in capsule or tablet form. The usual adult dosage ranges from 200 mg to 500 mg once or twice daily depending on the specific drug. Pediatric dosing is based on the child's weight, ranging from 6 to 20 mg/kg/day.

It's important to take the medication exactly as prescribed and to finish the entire course, even if you start feeling better. Stopping treatment early can allow bacteria to persist and develop resistance to cephalosporins.

How Long Do Oral Cephalosporins Take to Work?

Patients typically start seeing symptom relief within 24-48 hours after starting an oral cephalosporin. However, you should take the cephalosporin for the entire duration prescribed, even if you feel better, to fully eliminate the infection.

What Are Some Alternatives to Oral Third Generation Cephalosporins?

Some alternatives to oral third generation cephalosporins for treating bacterial infections include:

Amoxicillin/clavulanate
Dicloxacillin
Clindamycin
Doxycycline
Levofloxacin
Trimethoprim/sulfamethoxazole

The choice of antibiotic depends on factors like the type and location of infection, patient allergies, local resistance patterns, and drug cost or availability.

Key Takeaways About Oral Third Generation Cephalosporins

Oral third generation cephalosporins like cefixime, cefpodoxime and ceftibuten are broad-spectrum antibiotics used to treat a variety of bacterial infections.
They work by disrupting bacterial cell wall synthesis leading to cell death.
Cephalosporins are commonly prescribed for respiratory infections, urinary tract infections, ear infections, gonorrhea, and some skin infections.
Monitor for potential side effects like diarrhea, nausea, rash, and interactions with other medications.
Oral cephalosporins should not be used by those with severe penicillin or cephalosporin allergies.
Take the complete prescribed course to fully eliminate the infection and prevent antibiotic resistance.

Oral third generation cephalosporins are effective and widely used antibiotics. When taken properly, they provide safe and reliable treatment for a broad range of common bacterial infections.

FAQs

What bacteria do oral third generation cephalosporins treat?

They have expanded activity against gram-negative bacteria like E. coli, Klebsiella, and Proteus species. They also cover some gram-positive organisms like Streptococcus pneumoniae and Staphylococcus aureus.

Are oral cephalosporins safe during pregnancy?

Use caution when taking oral cephalosporins while pregnant. They may rarely cause damage to developing joints in the fetus. Weigh risks vs. benefits with your doctor.

Can you drink alcohol while taking cephalosporins?

Alcohol does not directly interact with cephalosporins, but drinking while sick can delay feeling better. Avoid heavy alcohol use until infection clears.

How long are cephalosporin antibiotics prescribed?

A typical course of oral cephalosporins is 5-7 days for simple infections and 7-14 days for more severe infections. Always complete the full course as prescribed.

What reduces the effectiveness of oral cephalosporins?

Vomiting, diarrhea, antacids with magnesium or aluminum, and prematurely stopping treatment can all impair efficacy. Take as prescribed to optimize results.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.