Although cephem antibiotics are important in a pediatrician’s armamentarium, they are overused to the detriment of patients, hospitals, and communities, despite the availability of sound alternatives. Going back to the basics on mechanisms of action, resistance, and pharmacokinetic and pharmacodynamic principles facilitates smarter use and preserves cures for tomorrow.

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The cephem antibiotics were first deployed in the 1960s but did not expand into broad use until the 1970s with the development of useful semisynthetic derivatives. The cephem class includes the cephalosporins and the cephamycins, of which more than 22 antibiotics are now in clinical use (Table 1). There is no doubt that the cephem antibiotics are important weapons in a practitioner’s armamentarium; they are the most widely prescribed and largest selling class of antibiotics, with $8.5 billion spent yearly worldwide. (1)

That said, cephems are also arguably...

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