Antibiotics: cephalosporins in neonates: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Antibiotics: cephalosporins in neonates

Sample item

A 7-day-old jaundiced neonate with sepsis has a serum bilirubin of 18 mg/dL and is receiving intravenous calcium gluconate. Which cephalosporin should be avoided?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Ceftriaxone

Ceftriaxone is highly protein bound, displaces bilirubin from albumin and risks kernicterus in hyperbilirubinaemic neonates. It also forms precipitates with calcium-containing infusions, with reported fatal lung and kidney deposits. Cefotaxime is the usual third-generation alternative in neonates.

Option by option

  • A. Ceftriaxone (correct)

    Correct. It displaces bilirubin and precipitates with intravenous calcium.

  • B. Cefazolin

    Cefazolin lacks this problem; it is mainly used for surgical prophylaxis and staphylococcal infection.

  • C. Cefepime

    Cefepime lacks this bilirubin displacement and calcium precipitation problem.

  • D. Cefotaxime

    Cefotaxime does not displace bilirubin significantly and is the preferred alternative.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Ceftriaxone. Ceftriaxone is highly protein bound, displaces bilirubin from albumin and risks kernicterus in hyperbilirubinaemic neonates.

Why is "Cefazolin" not the answer?

Cefazolin lacks this problem; it is mainly used for surgical prophylaxis and staphylococcal infection.

Why is "Cefepime" not the answer?

Cefepime lacks this bilirubin displacement and calcium precipitation problem.

Why is "Cefotaxime" not the answer?

Cefotaxime does not displace bilirubin significantly and is the preferred alternative.

What concept does this question test?

It tests Antibiotics: cephalosporins in neonates in Pharmacology. It also forms precipitates with calcium-containing infusions, with reported fatal lung and kidney deposits. Cefotaxime is the usual third-generation alternative in neonates.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antibiotics: cephalosporins in neonates?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.