[The third generation cephems for surgical infections].

The third generation cephems, Cefotaxime, Ceftizoxime, Cefmenoxime and Latamoxef, have been developed to aim opportunistic Gram negative pathogens and applied for surgical infections since 1980. Although they have excellent antibacterial activities in vitro against Enterobacter spp., indole positive Proteus spp., Pseudomonas spp. and Bacteroides spp., they show lower activities against Gram positive bacteria. Their pharmacokinetic characteristics are longer serum half-life, lower urinary excretion and higher biliary transmission without any metabolic inactivation in human body. Clinical trials of the third generation cephems to surgical infections in Japan revealed the average efficacy rate of 84% which might be better than that of the second generation cephems. It may be a discrepancy between their antibacterial spectrum and clinical results that responses in cases caused by Gram negatives did not exceed those by Gram positives. Clinical application of the third generation cephems should be limited to the surgical infections caused by Gram negatives in immunocompromised host to avoid the emergence of resistant strains.