Which generation of cephalosporin would be selected to treat complicated, drug-resistant meningitis?
1. Second
2. Third
3. Fourth
4. First
Correct Answer: 3
Rationale 1: The second-generation cephalosporins do not cross the blood–brain barrier in concentrations high enough to treat CNS infections.
Rationale 2: The third-generation cephalosporins can cross the blood–brain barrier but another generation is more capable of treating resistant organisms.
Rationale 3: The fourth-generation cephalosporins are capable of crossing the blood–brain barrier in sufficiently high concentrations to treat central nervous system infections such as meningitis. They also are more effective against organisms that have developed resistance to earlier cephalosporins.
Rationale 4: The first-generation cephalosporins do not cross the blood–brain barrier in concentrations high enough to treat CNS infections.
Global Rationale: First- and second-generation drugs do not cross the blood–brain barrier to any appreciable extent. Third-generation drugs are able to enter the CSF to treat CNS infections, but fourth generation cephalosporins are more effective against organisms that have developed resistance to earlier cephalosporins.
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