Cephalosporins
are novel beta-lactam antibiotics introduced into clinical practice against a
background
of rapidly increasing bacterial resistance. Since their introduction they have undergone
series of development and several new members of the group have been produced.As the
second millenium drew to a close, the whole world witnessed an exuberant growth
of novel antibiotics and, without doubt, the majority of antibiotics that were
introduced into clinical practice in the past two decades or so have been
cephalosporins. This development is
largely attributable to the relentless and enthusiastic efforts of the
pharmaceutical companies to combat the global problem of bacterial resistance
to antibiotics1.
Resistance to antibacterial drugs
has been shown to be increasing globally2 with the highest prevalence
of resistant strains found in the developing countries. For example, a nationwide survey in Nigeria
revealed that 78% of community-acquired pathogens produced beta lactamases
while more than 50% of most community isolates showed in-vitro resistance to
most commonly prescribed antibiotics3. It is against this gloomy background that the
cephalosporins were developed. At
present, scores of these agents are being marketed and several new ones are
becoming available each year.
The use of cephalosporins is more
common in the developed countries where they remain the most prescribed of all
the antimicrobial agents, and account for a large chunk of health care budget
each year1. This is not so in
most of the developing nations which are engrossed with problems of control of
malaria, onchocerciasis, tuberculosis, guinea worm and other infectious
diseases than concentrating on treating individual infections. Poverty has also played a part in the
apparent low usage of these rather expensive drugs in most of the third world
countries4.
The cephalosporins, like the
penicillins, are beta-lactam agents that provide broad-spectrum antimicrobial
coverage pertinent to many life-threatening infectious diseases commonly
encountered in clinical practice5.
These groups of drugs also have in common their classification into
subcategories or “generations” that delineate their usefulness in
specific-negative bacteria, pseudomonas
infections, or febrile neutropenic patients.
Understanding these subcategories is essential to both efficacious and
cost-effective use of these agents.
The story
of the cephalosporins is a very interesting and challenging one. They represent, perhaps, the most important
advancement in antimicrobial therapy.
The emergence of the cephalosporins
has provided the clinician with agents that offer a broad-spectrum of activity,
good patient acceptance, a well tolerated safety profile, and convenient dosage
regimes due to their unique
pharmacokinetic profiles.
They are all very good and effective
agents but their relative high cost appears to have precluded them from routine
use in general medical practice as well as in some specialized centres. Nevertheless, it is important to note that
many of these agents are life-savers and are drugs to have in all centres of
medical excellence.REFERENCES
1.
Rotimi, V.O. The cephalosporins: Past and Present. Nigerian
Medical Practitioners, 15:
47-50, 1988.
2.
O’Brien, T.F., Global Surveillance of antibiotic resistance. New England J.
Med. 326: 339, 1992.
3.
Oyelese, AO; Oyewo, E.A. The
menance of beta-lactamase production on antibiotic prescription in community
acquired-infections in Nigeria. Afr. J.
Med. med. Sci. 24: 125-130,
1995.
4.
Eniojukan, J.F.; Yusuf, I.A.
Antimicrobial therapy in Lagos University Teaching Hospital. A 2 year Retrospective Audit. Nig.
Qt. J. Hosp. Med. 6 (2): 104-109,
1996.
5.
Pollack, ES; Pollack, CV.
Antibiotic use in the emergency department: I. The penicillins and cephalosporins. Journal
of Emergency Medicine. 14 (2):
213-22, 1996.