- Based on most guidelines, only 3rd generation cephalosporins are indicated for treatment of Leptospirosis
- No pharmacological reasoning for the selection based on literature review.
- The only available reason is the efficacy of first generation cephalosporins has been less well-studied.
- Studies
- No studies have been carries out using Cefuroxime
In Vitro and In Vivo Activity of
First Generation Cephalosporins AgainstLeptospira. Am J Trop Med Hyg. 2011 Nov 1; 85(5): 905–908
- Efficacy of cefazolin and cephalexin in an acute lethal hamster model of leptospirosis was studied.
- Survival rates for cefazolin were 80%, 100%, and 100%, and survival rates for cephalexin were 50%, 80%, and 100% (treated with 5, 25, and 50 mg/kg per day for 5 days, respectively).
- Each treatment group showed improved survival compared with no treatment (P < 0.01)
Alexander AD, Rule PL. Penicillins, cephalosporins, and tetracyclines in treatment of hamsters with fatal leptospirosis. Antimicrob Agents Chemother. 1986;30:835–839
- first generation cephalosporins (cefadroxil and cephalexin), even in high doses, were not shown to be effective against leptospirosis in their hamster model.
- Their work did show a survival benefit for second (cefamandole) and third (cefoperazone, cefotaxime, and moxalactam) generation cephalosporin
References:
- http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011
- http://www.who.int/zoonoses/diseases/Leptospirosissurveillance
- http://bestpractice.bmj.com/best-practice/monograph/913/treatment/step-by-step.html
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