Adverse effects of third-generation cephalosporins

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Abstract
Review of the adverse experiences of patients whose records were submitted to the U.S. Food and Drug Administration reveals that the third-generation agents, cefoperazone, cefotaxime, ceftizoxime, and moxalactam share a low incidence of the adverse effects which have also been observed for the first-generation cephalosporins. These include pain and phlebitis at injection sites, immediate and delayed hypersensitivity reactions, various haematological disorders, nephrotoxicity, hepatotoxicity, gastrointestinal disturbances, and fever. The rates at which these were observed ranged from ≤ 1–12% and did not vary significantly among the third-generation agents. Additional adverse effects which have been observed more often among third-generation cephalosporins than first-generation agents are: suppression of endogenous gut flora leading to reduction in vitamin K synthesis and occasionally causing clinically significant bleeding, pseudomembranous colitis, and inhibition of acetaldehyde dehydrogenase, causing acute ethanol intolerance. The latter appears to be restricted to compounds which contain a methyltetrazolethiol group. The overall clinical experience to date indicates that these agents will enjoy low toxicity similar to that observed for the first-generation cephalosporins.

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