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Side-Effect Profiles of Newer-Generation Cephalosporins

FOR MANY YEARS, cephalosporins as a class have been considered safe compounds for clinical use, with the possible exception of cephaloridine. Aside from hypersensitivity phenomena, cephalosporins produced only uncommon instances of clinically significant adverse effects. Comparatively speaking, with regard to adverseeffect profiles, a cephalosporin is a cephalosporin is a cephalosporin. For the most part, side-effect differentiation was attempted on the basis of the incidence of phlebitis with intravenous administration and the degree of pain encountered with intramuscular administration. Cephalothin apparently was responsible for a significantly greater degree of phlebitis and pain when administered intramuscularly than were other competitive cephalosporins, such as cephapirin and cephradine. However, this seemingly significant difference in side effects has become a mute point since the reformulation of cephalothin several years ago. Until recently, there was little difference in toxicity among the available cephalosporins. However, the advent of the newergeneration cephalosporins (i.e., cefotaxime, moxalactam, and cefoperazone) clearly has demonstrated that these cephalosporins differ significantly in side effect profiles, such that therapeutic decisions regarding their use must include consideration of the differences in adverse effects. That is not to say that the differences in clinical adverse effects are the sole consideration in selecting a cephalosporin, but that prior to the introduction of the newer-generation cephalosporins, little regard to comparable side effects was necessary in the cephalosporin-selection process. Of the newer cephalosporins, specifically cefotaxime, moxalactam, and cefoperazone, the latter two agents have demonstrated adverse-effect profiles that distinguish them from cefotaxime. Although each of the newer cephalosporins has been associated with superinfection, there is no documentation demonstrating significant differences in superinfection potential or occurrence. Considerable noncomparative work and clinical impressions suggest that the overall prevalence of superinfection ranges between 1 and 10 percent for each of these agents. Since moxalactaru's release for clinical use in the U.S., adverse effects of ever-increasing frequency and