The first article in this series discussed the cephalosporin antibiotic agents as a class, including the similarities in their structure, antimicrobial action, and toxicity. Part II focuses on the difference between commercially available first- and second-“generation” agents.

The cephalosporins are classified using various criteria, including vulnerability to beta-lactamase hydrolysis and antibacterial activity. The latter classification is based on the in vitro activity of the individual agents, with each succeeding “generation” possessing a greater spectrum of activity than the previous generation(s).

There is increasing concern in the medical community regarding the safe handling and storage of biological materials procured from patients with Creutzfeldt-Jakob disease (CJD). Neurosurgeons have refused to operate on CJD patients, pathologists have refused to do autopsies on CJD patients, and hospitals have discharged CJD patients without confirmation of their diagnoses. This attitude was exemplified in the case of a director of a pathology laboratory who was so concerned about the safety of his laboratory personnel that he proposed to incinerate his entire collection of CJD slides. This extreme example is typical of the hysteria common among medical colleagues regarding the safe handling of CJD biological materials.

From time to time, health care workers are restricted from patient contact because of proven or suspected infectious illness or because of incubating disease after an exposure. The CDC Guideline for Infection Control in Hospital Personnel addresses a number of infectious illnesses and exposures which may require some type of employee restriction from patient contact. However, the Guideline does not address the administrative aspects that accompany putting an employee on a leave of absence for infection control purposes. This process is often complicated and questions frequently arise as to how an employee should be paid for the time lost from work. In general, there is no uniform way to approach the problem of “absence to prevent contagion.” As with many areas of infection control and employee health, hospitals can choose one of several options. However, the employee should never be penalized for reporting an infectious illness or exposure, and administrators should encourage reporting of proven or suspected disease or exposures (eg, exposure to chickenpox).