The in vitro activity of four oral cephalosporins was assessed in dilution tests with 50 isolates of the family Enterobacteriaceae possessing well-characterized mechanisms of resistance to Il-lactam antibiotics. The interaction of the drugs with a broad array of 3-lactamases was also determined in spectrophotometric assays and tests for enzyme induction. Overall, the percentages of strains susceptible to each of the study drugs were 82% for cefixime, 62% for cefuroxime, 58% for cephalexin, and 44% for cefaclor. The poor activity of the older cephalosporins was due to a high degree of susceptibility to hydrolysis by both plasmid-mediated and chromosomally mediated P-lactamases. For cefaclor, higher MICs were associated with higher levels of plasmid-mediated 3-lactamases in the strains. Resistance to cefuroxime was seen primarily among strains expressing high levels of class I or IV 1-lactamase. Resistance to cefixime was seen only among strains expressing high levels of class I enzymes. Neither cefixime nor cefuroxime was a strong inducer of class I ,I-lactamases, although enzyme induction did appear to play a role in cefuroxime resistance in a strain of Serratia marcescens. The consistently greater activity of cefixime over cefuroxime was found not to be due to greater drug permeation into the cell. Rather, it appeared to result from the high affinity of the drug for target enzymes.There has recently been intense activity in the development of new orally absorbable cephalosporins. Some of these compounds are directly absorbable in their active forms (2,6,7,10,11,13,16,28,30), while others are esters which must be enzymatically cleaved to their active forms after absoi-ption (3,5,9,17,18,20,27,29). Many of these newer compounds possess expanded antimicrobial spectra compared with spectra of older oral cephalosporins, which is thought to be due in large part to a diminished susceptibility to hydrolysis by 1-lactamases (1-6, 8, 9, 15-17, 19-21, 26, 27, 29). Thus, the purpose of this study was to assess various factors that might influence the activity of oral cephalosporins. To accomplish this, the interactions of four oral cephalosporins with a broad array of 1-lactamases were assessed, as was the activity of the cephalosporins against organisms possessing well-characterized mechanisms of resistance to 3-lactam antibiotics. Cephalexin, cefaclor, cefuroxime, and cefixime were chosen for study, since the two former drugs represent the older compounds and the latter represent two of the most P-lactamase stable of the newer compounds.MATERIALS AND METHODS Strains. Fifty isolates of diverse genera of the family Enterobacteriaceae were examined in this study. They included 23 Escherichia coli, 11 Klebsiella spp., 4 Enterobacter spp., 7 Citrobacter spp., 3 Serratia spp., and one each Providencia stuartii and Morganella morganii isolates. Most were clinical isolates, although three were laboratory-derived mutants from clinical isolates. Most were also resistant to multiple P-lactam antibiotics, and the mechanism(s) resp...