By Alan R. Hauser MD PhD
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In: Williams JD, ed. The Cephalosporin Antibiotics. Auckland, New Zealand: Adis Press; 1987. indd 37 12/15/11 2:24 AM 38 Antibiotic Basics for Clinicians In summary, the cephalosporins vary markedly in their activities, but the following generalizations can be made: (1) First-generation agents have good activity against aerobic gram-positive bacteria. (2) Second-generation agents have modest activity against aerobic gram-positive, aerobic gram-negative, and (in some cases) anaerobic bacteria. (3) Third-generation agents have strong activity against aerobic gram-negative bacteria.
A more worrisome complication associated with carbapenems is seizures. Patients with preexisting central nervous system disease and with renal insufﬁciency are most at risk for this complication and should be given these drugs with caution. Initially, meropenem was felt to be less likely to cause seizures than imipenem, but this is now controversial. Results of animal experiments suggest that doripenem is less likely to cause seizures than the other carbapenems. In summary, carbapenems have excellent activity against a broad spectrum of bacteria, including many aerobic gram-positive bacteria, most aerobic gram-negative bacteria, and most anaerobes.
This toxicity, however, is now known to be due to contaminants that resulted from the crude puriﬁcation process. Newer production techniques have greatly enhanced the safety proﬁle of vancomycin, while other agents, such as the penicillins, have been progressively limited in their use by increasing resistance. As a result, vancomycin has become a workhorse among antibacterial agents. With increasing use, however, its preeminent position, too, has been threatened by emerging resistance, especially among the enterococci.