An antibiotic of the 3rd generation cephalosporin group. II generation cephalosporins

According to their antimicrobial action, they are broad-spectrum antibiotics, resistant to penicillinase (if you forgot, I remind you that this is an enzyme in a bacterial cell that destroys penicillin).

Cephalosporins are semi-synthetic compounds. All synthesized derivatives are conditionally divided into 4 generations. With each generation, their stability, activity and spectrum of action increase. They are mainly used to treat infections caused by gram-negative bacteria (eg, kidney infections, cystitis), or gram-positive bacteria if penicillins have not been effective. Most cephalosporins are poorly absorbed from the gastrointestinal tract, some are taken orally (cephalexin).

Of the side effects to cephalosporins, allergy is most common, especially if there is an allergy to penicillins. There are also violations of the liver and kidneys, when injected, pain, burning, and an inflammatory reaction may occur. If drugs are used orally, digestion may be disturbed (abdominal pain, diarrhea, vomiting). The effect of cephalosporins on the fetus has not yet been sufficiently studied, therefore, pregnant women are prescribed only for health reasons.

1st generation cephalosporins:

Cefazolin

Not absorbed when taken orally, administered intramuscularly or intravenously. With intramuscular injection, the therapeutic concentration in the blood is maintained for a long time (administered every 8-12 hours, depending on the severity of the disease). For intramuscular administration, the contents of the vial are dissolved in 2-3 ml of isotonic NaCl (physical solution) or water for injection, injected deep into the muscle.

• Reflin powder for solution for injection 1g (Ranbaxi, India)
• Cefazolin sodium salt powder for solution for injection 1g
• Cefazolin sodium salt powder for solution for injection 500mg
• Totacef powder for solution for injection 1g (Bristol-Myers Squibb)
• Cefamezin powder for solution for injection 1g ("KRKA", Slovenia)
• Kefzol powder for solution for injection 1g ("Eli Lilly", USA).

Cefalexin

Stable in the acidic environment of the stomach, rapidly absorbed, especially before meals.

Take 4 times a day (every 6 hours). If there are diseases of the liver, kidneys, it is necessary to reduce the dose.

• Cephalexin caps. 250mg #20
• Lexin caps. 500mg №20 ("Hikma", Jordan)
• Lexin-125 powder for oral suspension 125mg/5ml 60ml ("Hikma", Jordan)
• Leksin-250 powder for oral suspension 250mg/5ml 60ml ("Hikma", Jordan)
• Ospexin granules for oral suspension 125mg/5ml 60ml ("Biochemie", Austria)
• Ospexin granules for oral suspension 250mg/5ml 60ml ("Biochemie", Austria)
• Ospeksin caps. 250mg №10 ("Biochemie", Austria)
• Ospeksin caps. 500mg №10 ("Biochemie", Austria)
• Sporidex powder for oral suspension 125mg/5ml 60ml (Ranbaxi, India)
• Sporidex caps. 250mg №30 ("Ranbaxi", India)
• Sporidex caps. 500 mg №10 ("Ranbaxi", India).

Cefadroxil

• duracef caps. 500mg №12 ("UPSA", France)
• Duracef powder for oral suspension 250mg/5ml 60ml ("UPSA", France).

2nd generation cephalosporins:

Cefuroxime

Administered 3-4 times a day intravenously or intramuscularly

• Zinacef powder for solution for injection 1.5g ("GlaxoWellcome", UK)
• Zinacef powder for solution for injection 250mg (GlaxoWellcome, UK)
• Zinacef powder for solution for injection 750mg ("GlaxoWellcome", UK).

Take 2 times a day.

• Zinnat granules for oral suspension 125mg/5ml 100ml ("GlaxoWellcome", UK)
• Zinnat tab.125mg №10 ("GlaxoWellcome", UK)
• Zinnat tab. 250mg №10 ("GlaxoWellcome", UK).

Cefoxitin

It is administered intramuscularly or intravenously every 8 hours. Use with extreme caution if there are violations of the liver and kidneys.

• Mefoxin powder for solution for injection 1g ("MSD", USA).

Broad spectrum of antimicrobial action. Taken 3 times a day. The course of treatment is usually 7-10 days. Side effects may include indigestion (nausea, vomiting, diarrhea), dizziness, headache, jaundice.

• Vercef caps. 250 mg №3 ("Ranbaxi", India).

3rd generation cephalosporins:

Significantly wider spectrum of action and antimicrobial activity

Cefotaxime

It is used intramuscularly and intravenously. When administered intramuscularly, 1 g of the powder is dissolved in 2 g of water for injection. Enter 2 times a day (every 12 hours). The preparation is accompanied by a solvent containing lidocaine to reduce the pain of the injection.

• Klaforan powder for solution for injection 1g (Hoechst Marion Roussel)
• Cefotaxime sodium salt powder for solution for injection 1g (Hoechst Marion Roussel).

Ceftazidime

It penetrates well into organs and tissues. Usually applied every 8-12 hours, depending on the severity of the infection. Dissolve in isotonic NaCl solution (physical solution) or 5% glucose solution. For intramuscular administration, it can be dissolved in 0.5% or 1% lidocaine solution. The volume of the solvent depends on the method of administration and the amount of powder in the vial. When water is added, the drug dissolves with the formation of bubbles, the pressure inside the vial increases, therefore it is recommended to add the solvent in parts and, after shaking the vial, insert the syringe needle into the stopper so that the gas comes out of the vial and the pressure returns to normal. The finished solution may have a color from light yellow to dark yellow.

• Fortum powder for solution for injection 1g ("GlaxoWellcome", UK)
• Fortum powder for solution for injection 500mg ("GlaxoWellcome", UK)
• Fortum powder for solution for injection 250 mg ("GlaxoWellcome", UK).

It penetrates well into organs and tissues. It is used intramuscularly and intravenously. When administered intramuscularly, 1 g of the powder is dissolved in 2 g of water for injection. Enter 1 time per day (every 24 hours). In diseases of the liver and kidneys, it is necessary to reduce the dose.

• Ceftriaxone sodium salt powder for solution for injection 1g (Ranbaxi, India)
• Ceftriaxone sodium salt powder for solution for injection 500mg (Ranbaxi, India)
• Oframax powder for solution for injection 1g (Ranbaxi, India).

4th generation cephalosporins:

High stability. Broad spectrum of activity - they are active against most known bacteria.

cefepime

Enter 2 times a day (every 12 hours) intramuscularly or intravenously. The course of treatment is usually 7-10 days. For intramuscular administration, it can be dissolved in 0.5% or 1% lidocaine solution, isotonic NaCl solution, 5% and 10% glucose solution. The volume of the solvent depends on the method of administration and the amount of powder in the vial. Usually the drug is well tolerated. The most common disorders of the digestive system and allergic reactions. It is not recommended to use if there is intolerance to other cephalosporins, penicillins or macrolide antibiotics. During storage, the solution or powder may darken, this does not affect its activity.

• Maximim powder for solution for injection (Bristol-Myers Squibb).

Often, cephalosporins in tablets are used to treat diseases of bacterial etiology. These medicines are antibiotics. The first drug from this group was obtained in 1964 (cephalothin). It was called so because it was obtained from cultures of microorganisms Cefalosporium acremonium. They belong to the class of imperfect mushrooms. Since then, a large number of cephalosporins have been successfully synthesized. What properties do these drugs have and when are they used?

Characteristics of cephalosporins in tablets

Cephalosporin antibiotics are used very often. Their main features:

• high activity against a wide range of bacteria;
• bactericidal effect;
• the possibility of using in various dosage forms (tablets, injections, capsules);
• the possibility of the formation of cross-allergy in patients allergic to Penicillin;
• resistant to the enzyme beta-lactamase;
• enhance their effect when combined with aminoglycosides.

Antibiotics of the cephalosporin series today are divided into several generations. There are 4 generations of these drugs. At the same time, 4th generation cephalosporins are administered only parenterally. It follows that tablet forms are represented by only three generations.

From the 1st generation, Cefalexin (Keflex) is produced in tablets. The second generation includes tablets Cefuroxime axetil and Cefaclor. As for the 3rd generation, this group includes Cefixime and Ceftibuten. Each generation has its own characteristics. It is important that 1st generation drugs are less resistant to beta-lactamases.

Indications for use

This series of antibacterial drugs has a bactericidal effect. This is achieved by damaging the cell membrane of microorganisms. To a greater extent, these drugs are active against gram-negative bacteria. The effectiveness of antibiotics of the cephalosporin group belonging to the 1st generation is lower than that of the 3rd generation.

1st generation cephalosporin tablets kill staphylococci, streptococci, neisseria, E. coli, shigella and salmonella. It is important that most enterobacteria (Proteus, community-acquired strains of Escherichia coli) are resistant to these drugs.

Antimicrobial cephalosporins of the 2nd generation are characterized by a wider spectrum of antimicrobial activity. Enterobacteria, staphylococci, streptococci, gonococci, Neisseria are sensitive to Cefuroxime and Cefaclor. Pneumococci, Pseudomonas, and some anaerobes are resistant. Most often, 3rd generation drugs are used to treat patients.

Unlike parenteral cephalosporins (Cefotaxime and Ceftriaxone), tablets are less effective. For example, Ceftibuten has practically no effect on viridescent streptococci and pneumococci. Enterobacter, serration and some other bacteria are resistant. 3rd generation cephalosporins can be used to treat:

• respiratory diseases (bronchitis, pneumonia, empyema, sinusitis, otitis media, pharyngitis, tonsillitis);
• gonorrhea;
• pathology of the organs of the genitourinary tract (inflammation of the urethra, bladder, pyelonephritis);
• Lyme disease;
• impetigo;
• furunculosis.

1st generation cephalosporins

Cefalexin is often used in medical practice. This remedy is taken orally in the form of tablets. The drug is used to treat diseases of the respiratory system (inflammation of the pharynx, sinusitis, tonsillitis, bronchitis, bronchopneumonia, lung abscess), pathologies of the urinary system, skin diseases and osteomyelitis.

The drug has a high bioavailability (90-95%). Cephalexin practically does not penetrate the blood-brain barrier, so it is not advisable to use it for the treatment of meningitis. Cefalexin is not recommended for use during the period of gestation or feeding the baby. The drug is not prescribed for children under 3 years of age and with intolerance to the drug.

Like most other cephalosporins, Cefalexin tablets can cause various adverse reactions. Possible side effects include allergic reactions, dyspeptic disorders, dizziness, weakness, convulsions, increased agitation, inflammation of the joints, joint pain, impaired blood clotting.

The duration of treatment with Cefalexin is determined by the doctor. Most often, treatment lasts 1-2 weeks. Tablets are taken immediately before meals.

2nd generation antibiotics

Of the 2nd generation tablet preparations, Zinnat and its analogues can be taken. The main active ingredient of Zinnat is Cefuroxime axetil. Zinnat is produced in the form of white coated tablets. Tablets have a biconvex shape. The drug is prescribed for a period of 5 to 10 days. Zinnat can be used to treat both adults and children over 3 years old. The medicine may cause the following unwanted effects:

• changes in blood counts (eosinophilia, thrombocytopenia, leukopenia);
• rash;
• urticaria;
• headache;
• dizziness;
• violation of the stool by the type of diarrhea;
• stomach ache;
• nausea;
• an increase in the concentration of liver enzymes.

For persons who have kidney pathology, ulcerative colitis or other chronic diseases of the gastrointestinal tract, Zinnat is prescribed with caution. It is important that if the terms of treatment are not observed (long-term use), infection of the body with fungi of the genus Candida is possible.

Tablets 3rd generation

3rd generation cephalosporins are the most popular today. Of the tablet forms of the third generation, Suprax or Cemidexor are often prescribed to patients. Suprax tablets have a pale orange color and a strawberry odor. They contain Cefixime and excipients.

Suprax is effective against the following microorganisms: streptococci, staphylococci, Haemophilus influenzae, Moraxella, Escherichia coli, Proteus, Neisseria. Listeria, Pseudomonas, Enterococcus, Enterobacter, Bacteroids, Clostridia are resistant to the drug. The daily dose of the drug depends on body weight. Suprax is advisable to use for the treatment of the following diseases:

• tonsillitis and pharyngitis caused by streptococci;
• otitis media;
• acute form of inflammation of the bronchi;
• uncomplicated gonorrhea;
• shigellosis;
• uncomplicated urethritis, pyelonephritis, cystitis;
• chronic bronchitis in the acute stage.

The limitation for the use of Suprax in childhood is body weight less than 25 kg. In addition, it is not recommended to use Suprax tablets for kidney pathology. Thus, cephalosporins are effective antimicrobial agents.

Cephalosporin I generation

Active substance

Release form, composition and packaging

Capsules gelatin, size No. 2, with a light green body and lid; contents of capsules - granular powder from white to yellowish color.

The composition of the capsule shell: titanium dioxide (E171), iron dye yellow oxide (E172), (Indigotin I) (E132), gelatin.

Capsules gelatin, size No. 0, with a dark green cap and a greenish-yellow body; contents of capsules - granular powder from white to yellowish color.

Excipients: magnesium stearate, microcrystalline cellulose PH 102.

The composition of the capsule shell: titanium dioxide (E171), iron dye yellow oxide (E172), iron dye black oxide (E172), indigo carmine (Indigotin I) (E132), gelatin.

8 pcs. - blisters (2) - packs of cardboard.

Granules for suspension for oral administration yellow-orange; when water is added, a yellow-orange suspension with a characteristic fruity odor is formed.

Excipients: sodium saccharinate, citric acid anhydride, iron dye yellow oxide (E172), guar gum, sodium benzoate, simethicone S 184, sucrose, strawberry flavor, apple flavor, raspberry flavor, tutti frutti flavor.

40 g (for the preparation of 100 ml suspension) - dark glass bottles (1) complete with a measuring spoon of 5 ml and a risk for a volume of 2.5 ml - packs of cardboard.

pharmachologic effect

Cephalosporin antibiotic of the first generation. It acts bactericidal, disrupts the synthesis of the cell wall of microorganisms. Resistant to lactamases.

Has a wide spectrum of activity. Active against Gram-positive microorganisms- Staphylococcus spp. (including Streptococcus pneumoniae, Streptococcus pyogenes), Corynebacterium diphtheriae; Gram-negative microorganisms- Neisseria meningitidis, Neisseria gonorrhoeae, Shigella spp., Salmonella spp., Escherichia coli, Klebsiella spp. (including Klebsiella pneumoniae), Moraxella catarrhalis, Proteus mirabilis; Treponema spp., radiant fungi.

Ineffective against Pseudomonas aeruginosa, Proteus spp. (indole-positive strains), Morganella morganii, Mycobacterium tuberculosis, Enterococcus faecalis, Haemophilus spp., Enterobacter spp., Serratia spp., Pseudomonas spp., Aeromonas spp., Acinetobacter spp., methicillin-resistant strains, anaerobic microorganisms.

Resistant to penicillinase of staphylococci, but destroyed by cephalosporinase of gram-negative microorganisms.

Pharmacokinetics

After oral administration, it is rapidly and well absorbed. Bioavailability - 90-95%, food intake slows down absorption, but does not affect its completeness. The time to reach C max after oral administration is 0.25, 0.5 or 1 g - 1 hour, the value of C max is 9, 18 and 32 μg / ml, respectively.

Therapeutic concentration is maintained for 4-6 hours Communication with proteins - 10-15%. V d - 0.26 l / kg.

It is distributed relatively evenly in various tissues and body fluids: lungs, liver, heart, kidneys, bile, gallbladder, bones, joints, respiratory tract. Poorly penetrates through the unchanged BBB. It passes through the placenta, is excreted in breast milk in a small amount, and is found in the amniotic fluid.

Not metabolized.

T 1/2 - 0.9-1.2 hours. Total clearance - 380 ml / min. Excreted by the kidneys - 70-89% unchanged (2/3 - glomerular filtration, 1/3 - tubular secretion); with bile - 0.5%. Renal clearance - 210 ml / min.

In case of violation of the excretory function of the kidneys, the concentration in the blood increases, and the time of excretion by the kidneys lengthens, T 1/2 after ingestion - 5-30 hours. Moderately excreted by hemodialysis, well - by peritoneal dialysis.

Indications

- infections of the upper and lower respiratory tract (pharyngitis, otitis media, sinusitis, tonsillitis, bronchitis, acute and exacerbation of chronic pneumonia, bronchopneumonia, empyema and lung abscess);

- infections of the genitourinary system (pyelonephritis, cystitis, urethritis, prostatitis, epididymitis, endometritis, gonorrhea, vulvovaginitis);

- infections of the skin and soft tissues (furunculosis, abscess, phlegmon, pyoderma, lymphadenitis, lymphangitis);

- infections of bones and joints (including osteomyelitis).

Contraindications

- children's age up to 3 years (for the dosage form - capsules);

- hypersensitivity (including to other beta-lactam antibiotics).

In patients with impaired renal function, cumulation is possible (correction of the dosing regimen is required).

In staphylococcal infections, there is cross-resistance between cephalosporins and isoxazolylpenicillins.

For adult patients with impaired renal function, the daily dose is reduced taking into account the value of CC: with QC 5-20 ml/min the maximum daily dose is 1.5 g / day; at CC less than 5 ml / min- 0.5 g / day. The daily dose is divided into 4 doses.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

List B. Store in a dry, dark place, out of the reach of children, at a temperature of 15° to 25°C. Shelf life - 3 years.

There are not as many different 3rd generation cephalosporins in tablets as powders for suspensions or liquids for injections. But their effectiveness is unlikely to be challenged by anyone. These are indispensable antibacterial drugs. They are able to destroy even those pathogens that have managed to develop resistance to most other medicines.

What is the difference between cephalosporins 1,2 and 3 generations in tablets?

It is impossible to say that these are new generation drugs. They were discovered back in the twentieth century, at the end of the forties. The higher the generation number, the newer the drug, and, accordingly, more effective. The main advantage of younger drugs is that they are active against a much larger number of different bacteria.

According to the instructions, most 3rd generation cephalosporins in tablets are able to fight dangerous aerobic gram-negative bacteria. Their popularity is also explained by the fact that antibiotics are strong enough to resist the three main pathogens that cause meningitis. The older preparations, alas, cannot boast of.

List of 3rd generation cephalosporin drugs in tablets

There are two main third-generation cephalosporins, on the basis of which all existing group antibiotics are produced in tablets:

1. Cefixime popular due to the fact that it affects almost the entire list of pathogenic microorganisms. It is active against streptococci, meningococci, staphylococci, gonorrhea, serration, cytobacter, Escherichia, Klebsiella, conduction, hemophilus, anaerobic coccal infections. The bioavailability of the drug is approximately 50%. You can drink regardless of meals. The optimal daily dosage for an adult is 400 mg. The drug is excreted in the bile.
2. Ceftibuten- another third generation cephalosporin tablets. Of all the antibiotics in its group, it is considered the most resistant to β-lactamases, substances that pathogenic microorganisms produce for their own protection. At the same time, extended-spectrum β-lactamases continue to pose a danger to the drug. Compared to Cefixime, Ceftibuten has a higher bioavailability of about 65%. Therefore, it is prescribed more often as part of stepwise therapy after parenteral treatment.

The list of 3rd generation cephalosporins in tablets, in which the main active substance is Cefixime or Ceftibuten, is as follows.

Cephalosporins are a group of antibiotics that are derived from 7-aminocephalosporic acid. Their main feature is high resistance to beta-lactamases in comparison with penicillins. Also, these drugs have a high ability to destroy bacteria (bactericidal) and a very wide spectrum of action, especially against staphylococci.

Another advantage of cephalosporins is their significant chemotherapeutic activity due to the fact that they cause lysis (dissolution) of the outer membrane of a dividing bacterial cell.

Antibiotics of the cephalosporin group

Cephalosporins are a group of antibiotics that are divided along the route of administration into the body into oral (in the form of tablets, syrups, suspensions) and parenteral (in the form of solutions for intramuscular and intravenous administration).

To date, there are 2316 drugs under 220 trade names. Among them, 25 active substances are distinguished.

The most common is the classification of cephalosporins by generation. To date, 5 generations are known, the representatives of which are described in the table:

All of the above antibiotics have a bactericidal effect, that is, they kill bacteria. This happens by destroying the outer wall of the bacterial cell.

Preparations of this group are active in the fight against a wide range of pathogenic microflora, and this ability increases from generation to generation.

The list of bacteria susceptible to cephalosporins is described in the table below:

1st generation oral cephalosporins

These include the active ingredients cephalexin and cefadroxil.

Cefalexin

On the shelves of pharmacies, cephalexin can be found under the following names:

• Cephalexin.
• Keflex.
• Ospeksin.
• Palettex.
• Cefaklen.
• Soleksin.
• Felexin.
• Piassan.

The drug exhibits predominant activity in the treatment of diseases, the causative agents of which are:

• Staphylococci - Staphylococcus spp. (not producing and producing penicillinase).
• Epidermal staphylococci - Staphylococcus epidermidis (penicillin-resistant strains).
• Streptococci - Streptococcus spp. (including Streptococcus pneumoniae and Streptococcus pyogenes).
• Corynebacterium and clostridia - Corynebacterium diphtheriae, Clostridium spp.

To a lesser extent, it reacts to gram-negative microorganisms, such as:

• Meningococcus - Neisseria meningitidis.
• Gonorrhea - Neisseria gonorrhoeae.
• Shigella and salmonella - Shigella spp., Salmonella spp.
• E.coli bacterium.
• Moraxella catarrhalis - Moraxella catarrhalis.
• Klebsiella pneumonia - Klebsiella pneumoniae.
• Treponema - Treponema spp.

It is ineffective against Pseudomonas aeruginosa, mirabilis proteus (indole-positive strains), Mycobacterium tuberculosis, anaerobes.

When administered orally, the bioavailability of the drug is 95%, but high concentrations in tissues and blood are not observed. The half-life is 1 hour.

Cephalexin is used for:

• staphylococcal and streptococcal infections of the skin and soft tissues;
• staphylococcal infections of ENT organs, upper and lower respiratory tract;
• various diseases in gynecology, urology, venereology.

Contraindications for the appointment are hypersensitivity to any cephalosporins and penicillins and children under 6 months of age.

Possible side effects from the use of the drug:

• headache;
• dizziness;
• changes in the cellular composition of the blood;
• dyspeptic phenomena;
• vulvovaginitis;
• hives;
• skin rash;
• anaphylactic shock.

The dosage regimen depends on the specific drug and the severity of the disease.

Cefadroxil

Cefadroxil is found under two trade names:

• Duracef.
• Biodroxil.

The drug is active against gram-positive and gram-negative microflora, Klebsiella, Proteus and Escherichia coli, but is useless in the fight against enterococci and enterobacteria.

Therapeutic concentration is retained in the blood for up to 12 hours. Most of the drug is excreted by the kidneys during the day.

The scope of cefadroxil are:

• infectious diseases of the skin and soft tissues;
• urinary tract infections;
• tonsillitis;
• adenoiditis.

The drug is contraindicated in case of intolerance to other cephalosporins and penicillins, while breastfeeding. Side effects:

• dyspepsia;
• stool disorders;
• candidiasis;
• skin allergic reactions.

2nd generation cephalosporins

This group includes medicines based on the active substances cefaclor and cefuroxime.

Cefaclor

Appears under the names:

• Ceklor.
• Cefaclor.
• Alphacet.

The drugs are used to treat infectious diseases, the causative agents of which are:

• staphylococci;
• streptococci;
• Neisseria;
• citrobacter;
• moraxella;
• bacteroid.

The maximum concentration is reached within an hour. The drug is excreted by the kidneys within 1-1.5 hours.

Contraindications are the same as for other cephalosporins. Side effects: dyspepsia, constipation, hepatitis, dizziness, anxiety, insomnia, violation of the cellular composition of the blood towards a decrease in the number of elements, impaired renal function, candidiasis.

Cefuroxime

Trade names of the drug:

• Zinnat.
• Cefuroxime.
• Cefurabol.
• Aksetin.
• Ketotsef.

A distinctive feature of this antibiotic compared to other cephalosporins is its ability to act on strains resistant to ampicillin and penicillin. Thus, the drug is effective in the fight against aerobic gram-positive and gram-negative microorganisms, including those with the ability to produce penicillinase.

The scope of the antibiotic is very wide: it is prescribed for infectious lesions of the respiratory tract, ENT organs, urinary tract, skin, soft tissues.

An absolute contraindication for admission is intolerance to cephalosporins and penicillins; limited medication is used for diseases of the gastrointestinal tract, exhaustion.

3rd generation drugs

These include cefixime and ceftibuten.

Cefixime

Appears under the names:

• Suprax.
• Panceph.
• Suprax Solutab.
• Cefspan.

For the treatment of children, Suprax Solutab is optimally suited. This form of release differs from all others in that the tablets can be taken whole with water or diluted in a small amount of water, depending on how it is more convenient for the baby to take the medicine.

Gram-positive and gram-negative microbes are sensitive to cefixime:

• streptococci;
• Neisseria;
• moraxella;
• bacteroid.

Pseudomonas aeruginosa, staphylococcus, listeria have resistance to it.

Indications for use are infections caused by the above bacteria; damage to the respiratory tract, gastrointestinal tract, urinary tract.

Contraindications and side effects are the same as for other cephalosporins.

Ceftibuten

On the shelves of pharmacies, the substance is found under the name Cedex.

Sensitivity to ceftibuten have:

• streptococci;
• staphylococci;
• hemophilic and Escherichia coli;
• moraxella;
• salmonella;
• shigella.

Indications for appointment are:

• infections of the upper and lower respiratory tract;
• enteritis and gastroenteritis in children caused by shigella and salmonella;
• otitis media;
• acute and chronic infections of the genitourinary system.

Contraindications - intolerance and children under 6 months of age.

Side effects described in the instructions for use:

• candidiasis;
• vaginitis;
• pseudomembranous colitis;
• constipation;
• dyspeptic phenomena;
• dizziness;
• paresthesia;
• headache;
• dyspnea;
• impaired renal function.

Cephalosporins of the 4th and 5th generation are presented by drugs for parenteral administration.