Abstract

CLINICAL PHARMACOLOGY OF CEPHALOSPORINS IN INFANTS AND CHILDREN

Prof. Gian Maria Pacifici

ABSTRACT

The cephalosporins used to treat paediatric infections are: cefalexin, cefradine, and cefaclor (first-generation cephalosporins) cefuroxime, and ceflacor (second-generation cephalosporins), cefixime, cefotaxime, and ceftriaxone (third-generation cephalosporins), and ceftazidime (antipseudomonal cephalosporin). Cefalexin, cefuroxime, cefotaxime, ceftriazone, and cefotaxime are used to treat newborns and children, whereas cefradine, cefadroxil, ceflacor and cefixime are used to treat children. The pharmacokinetics of these cephalosporins have been studied and the elimination half-life of cefalexin, cefradine, cefadroxil, cefuroxime, ceflacor, cefixime, cefotaxime, ceftriaxone, cefotaxime, and ceftazidime ranges from 0.8 to 2.1 hours, whereas that of ceftriaxone is about 5.5 hours. The treatment of infections caused by different bacteria has been described for cefalexin, cefradine, cefadroxil, cefuroxime, cefaclor, cefixime, cefotaxime, ceftriaxone, and ceftazidime. Cefalexin, cefuroxime, cefotaxime, desacetylcefotaxime, ceftriaxone, and ceftazidime penetrate into the cerebrospinal fluid of infants and children in significant amounts. Cefalexin, cefuroxime, cefaclor, cefotaxime, desacetylcefotaxime, ceftriaxone, and ceftazidime successfully treated the meningitis caused by different bacteria in infants and children. The transfer of cefradine, cefuroxime, ceftriazone, and ceftazidime across the human placenta has been reported and these cephalosporins are promptly transferred from the maternal serum to the umbilical cord serum. Cefazolin, cefradine, cefadroxil, cefuroxime, cefaclor, cefotaxime, ceftriaxone and ceftazidime poorly migrate into the breast-milk. The aim of this study is to review administration, pharmacokinetics, treatment of bacterial infections, penetration into the cerebrospinal fluid, treatment of bacterial meningitis, transfer across the human placenta, and migration into the breast-milk for cefalexin cefradine, cefadroxil, cefuroxime, cefaclor, cefixime, cefotaxime, ceftriaxone, and ceftazidime.

Keywords: Breast-milk, cephalosporins, cerebrospinal fluid, dosing, meningitis, pharmacokinetics, placental-transfer, and treatment.