Currently there are only two drugs in this category, ceftobiprole and ceftaroline. These new drugs are also the only β-lactam antibiotics that are effective against methicillin-resistant-Staphylococcus-aureus (MRSA). Ceftobiprole is a pyrrolidinone-3-ylidenemethyl cephem. The C-3 side chain was specifically designed to have a strong binding affinity to PBP2a and PBP2x. PBP2a is known to give staphylococci resistance to other β-lactam drugs and PBPx does the same for pneumococci. Ceftobiprole also has an aminothiazoyl-hydroxyimino side chain at the C-7 position which is known to give good resistance to β-lactamase from S. aureus. Together these active groups make ceftobiprole bactericidal to MRSA. Ceftobiprole has poor water solubility and is therefore administered intravenously as an ester prodrug called ceftobiprole medocaril. It is rapidly broken down into active ceftobiprole by plasma esterases.
Ceftaroline was developed from the fourth generation cephalosporin cefozopran. It retains the alkoxyimino group at position C-7 from earlier generations so it is fairly stable in the presence of many β-lactamases. Since MRSA and penicillin-resistant Streptococcus pneumoniae have resistance dedicated to new types of PBP, PBP2a and PBP2x respectively, both ceftaroline and ceftobiprole have C-3 side chains specially engineered to bind these new PBP. In the case of ceftaroline this side chain contains a 2-thioazolythio spacer linkage optimised for its anti-MRSA activity. Ceftaroline has low water solubility but this problem was overcome by attaching a N-phosphonoamino group to the molecule making the intravenous prodrug ceftaroline fosamil. The prodrug is dephosphorylated in plasma to form active ceftaroline.