Ceftaroline is a fifth-generation broad-spectrum cephalosporin with potent antimicrobial activity against Gram-positive and Gram-negative pathogens. Ceftaroline is the bioactive metabolite of ceftaroline fosamil, an N-phosphonoamino water-soluble cephalosporin prodrug, which is rapidly converted in vivo upon the hydrolysis of the phosphonate group by plasma phosphatises. Ceftaroline fosamil is being developed by Forest Laboratories, under a license from Takeda. In 2010, the U.S. Food and Drug Administration (FDA) approved ceftaroline fosamil for use in the treatment of acute bacterial skin and skin structure infections as well as community-acquired pneumonia. Ceftaroline has bactericidal activity against methicillin-resistant Staphylococcus aureus, therefore serving as an attractive alternative agent for the treatment of methicillin-resistant Staphylococcus aureus bacteremia when approved agents are contraindicated or treatment failures have occurred. Like other β-lactams, ceftaroline’s mechanism of action is mediated by binding to the penicillin-binding protein (PBP), the enzyme mediating the cross-linking transpeptidation of the peptidoglycan which are the terminal steps in completing formation of the bacterial cell wall. MRSA strains have a mutated PBP2a which prohibits β-lactam antibiotics from accessing its active site that mediates the transpeptidation reaction. Ceftaroline possesses an ethoxyimino side-chain mimicking a portion of a cell wall structure, which acts as a “Trojan horse”, allosterically opening and facilitating access to the active site of the PBP2a. Based on clinical trial data to date, ceftaroline appears to be safe and well-tolerated. Since ceftaroline is a cephalosporin, it has caused serious hypersensitivity reactions in patients who are allergic to cephalosporins and among some patients with penicillin allergies.

Cefditoren pivoxil is a semi-synthetic cephalosporin antibiotic for oral administration. It is a 3rd generation cephalosporin that is FDA approved for the treatment of acute bacterial exacerbation of chronic bronchitis, community acquired pneumonia, infection of skin and/or subcutaneous tissue, and pharyngitis/tonsillitis. Cefditoren is a cephalosporin with antibacterial activity against gram-positive and gram-negative pathogens. The bactericidal activity of cefditoren results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs). Common adverse reactions include diarrhea, nausea and candida vaginitis. Co-administration of a single dose of an antacid which contained both magnesium (800 mg) and aluminum (900 mg) hydroxides or co-administration of a single dose of intravenously administered famotidine (20 mg) reduced the oral absorption of a single 400 mg dose of cefditoren pivoxil administered following a meal. Co-administration of probenecid with cefditoren pivoxil resulted in an increase in the plasma exposure of cefditoren.

Loracarbef (KT3777) is carbacephem antibiotic structurally identical to cefaclor, except that the sulfur atom of position 1 of the cephem nucleus has been replaced by carbon. It showed good affinity for penicillin-binding proteins. At low concentrations (< 2 mg/L) in vitro, it inhibits Streptococcus pneumoniae, S. pyogenes, beta-haemolytic streptococci groups B, C and G. Proteus mirabilis and Moraxella catarrhalis, including beta-lactamase-producing strains. At therapeutic plasma concentrations it is also active in vitro against most strains of Staphylococcus aureus, S. saprophyticus, Escherichia coli and beta-lactamase-positive and -negative strains of Haemophilus influenzae. Loracarbef has been indicated in the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms.

Cefprozil is a 2nd generation cephalosporin that is FDA approved for the treatment of mild to moderate infections of upper respiratory tract, lower respiratory tract, and uncomplicated skin and skin-structure infections. Cefprozil, like the penicillins, is a beta-lactam antibiotic. By binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, it inhibits the third and last stage of bacterial cell wall synthesis. Common adverse reactions include diarrhea, nausea, vomiting, dizziness, abdominal pain and vaginitis. Nephrotoxicity has been reported following concomitant administration of aminoglycoside antibiotics and cephalosporin antibiotics. Concomitant administration of probenecid doubled the AUC for cefprozil.

Loracarbef (KT3777) is carbacephem antibiotic structurally identical to cefaclor, except that the sulfur atom of position 1 of the cephem nucleus has been replaced by carbon. It showed good affinity for penicillin-binding proteins. At low concentrations (< 2 mg/L) in vitro, it inhibits Streptococcus pneumoniae, S. pyogenes, beta-haemolytic streptococci groups B, C and G. Proteus mirabilis and Moraxella catarrhalis, including beta-lactamase-producing strains. At therapeutic plasma concentrations it is also active in vitro against most strains of Staphylococcus aureus, S. saprophyticus, Escherichia coli and beta-lactamase-positive and -negative strains of Haemophilus influenzae. Loracarbef has been indicated in the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms.

Cephradine is a semisynthetic cephalosporin antibiotic. Cephradine is active against the following organisms in vitro: Group A beta-hemolytic streptococci; Staphylococci, including coagulase-positive, coagulase-negative, and penicillinase-producing strains; Streptococcus pneumoniae (formerly Diplococcus pneumoniae); Escherichia coli; Proteus mirabilis; Klebsiella species; Hemophilus influenza. It works by stopping the growth of bacteria. It is used to treat a wide variety of bacterial infections (e.g., skin, ear, respiratory and urinary tract infections). Pseudomembranous colitis has been reported in patients receiving cephradine both orally and intravenously. Diarrhea generally starts 1 to 16 days after starting cephradine therapy. Gastrointestinal side effects have included nausea, vomiting. Hypersensitivity reactions have included rash, urticaria, pruritus, and joint pain. Bacteriostats may interfere with the bactericidal action of cephalosporins in acute infection; other agents, e.g., aminoglycosides, colistin, polymyxins, vancomycin, may increase the possibility of nephrotoxicity.