Fourth Generation Cephalosporins

Characteristics and Clinical Applications

• The Infectious Diseases Society of America recommends fourth-generation cephalosporins, such as cefepime, for severe community-acquired infections requiring broader spectrum coverage 2, 5
• Fourth-generation cephalosporins have activity against AmpC-producing organisms, which distinguishes them from third-generation cephalosporins 1
• The American Thoracic Society suggests that fourth-generation cephalosporins can be used for empiric treatment of high-severity infections, including those caused by ESBL-producing Enterobacteriaceae, though this use is controversial 3, 4
• When combined with metronidazole, fourth-generation cephalosporins can be used for intra-abdominal infections requiring anaerobic coverage 1, 2
• Fourth-generation cephalosporins should be reserved for serious infections to minimize development of resistance 1
• For intra-abdominal infections, cefepime should be combined with metronidazole due to lack of anti-anaerobic activity 1, 2