Adverse events of cephalosporins in the pediatric population: a comprehensive review

Background: Cephalosporins are the second most prescribed antibiotics worldwide and are applied for a wide range of infective indications. However, there is limited information about the toxicity profile of cephalosporins in pediatrics. Consequently, the aim of this narrative review is to provide a complete overview of the toxicity associated with cephalosporin treatment in children. Areas covered: Adverse events (AEs) and toxicity of cephalosporin antibiotics in pediatrics are reviewed. Expert opinion/commentary: Overall, 35 studies concerning AEs in cephalosporins were identified. Most AEs were reported in the system organ classes (SOC) gastrointestinal (GI), infections and infestations, and skin and subcutaneous. For oral administration, the most common AE of the GI SOC were diarrhea with an incidence rate varying between from 0.6% to 15.2%, for which cefdinir was the most reported cephalosporin with AE. Observed incidence rates for a diverse spectrum of SOC and AEs varied widely due to heterogeneity in study populations and lack of AE reporting criteria. This narrative review provides a complete overview of reported AEs in literature caused by cephalosporins in pediatrics. In the future, cephalosporin therapeutic drug monitoring might provide insights into toxicity threshold concentrations.