infections in the era of antimicrobial resistance: Insights into cephalosporin use

Abstract

Background causes severe bacterial diarrhea, especially in children in low- and middle-income countries. Rising antimicrobial resistance (AMR), including multidrug-resistant (MDR) and ESBL-producing strains, threatens empirical treatment, particularly cephalosporins. Methods We conducted a structured narrative review of PubMed, Scopus, Web of Science, ScienceDirect, and WHO GLASS. Included studies comprised randomized trials, cohorts, case series, and relevant in vitro studies. Quality was appraised using Joanna Briggs Institute checklists; findings were synthesized narratively. Results Third-generation cephalosporins (ceftriaxone, cefotaxime) remain highly effective for severeinfections in hospitalized and pediatric patients when isolates are susceptible. Resistance varies regionally, with higher ESBL prevalence in East and South Asia. Resistance mechanisms include ESBLs, efflux pumps, PBP mutations, and altered membrane permeability. Susceptibility-guided therapy yields favorable outcomes, but ESBL/XDR strains cause treatment failures, longer hospital stays, and carbapenem use. Conclusion Cephalosporins are critical for severe shigellosis but are increasingly compromised by AMR. Structured surveillance, susceptibility-guided therapy, and stewardship are essential. Complementary strategies (vaccines, probiotics, phage therapy, novel antibiotics) are urgently needed. abs0010 Highlights • Ceftriaxone and cefotaxime are key for severe, drug-resistant Shigella in children. u0010 • ESBL production increasingly compromises cephalosporin efficacy in many regions. u0015 • Resistance arises via enzymes, efflux pumps, PBP mutations, and mobile genetic elements. u0020 • Future strategies include phage therapy, vaccines, and improved antimicrobial stewardship. u0025 simple ulist0010 author-highlights abs0015