Okay, let's talk about bacterial resistance,
and I mean those nasty penicillinases.
Remember when we talked about the
4 different groups of penicillins?
There was penicillinase resistant,
and extended-spectrum penicillins.
Well, now, I want to talk about how that
penicillinase is such a pain, okay?
Beta-lactamases are bacteria
that are produced enzymes
that make the penicillin inactive.
So, these are bacteria that produce
enzymes that inactivate penicillin.
So, if I give a patient penicillin
or other Beta-lactams, they're not
effective in treating the infection.
So if I have some penicillinases,
there are some enzymes that are going to
make penicillin completely ineffective.
Okay, so what can we do?
Well, they came up with a brilliant solution.
That's why you see right there the word
"winning combinations," and that's
what I want you to think about.
When you see bacterial resistance,
you're thinking about penicillinases,
I want you to think --
because if we put some combinations
together with a penicillin,
things go much, much better. The
odds are now in our favor.
Thank you, Hunger Games.
So, the chemicals or drugs
that we've developed
to inhibit these enzymes are
called clavulanic acid,
tazobactam, or sulbactam.
So, if I put 1 of these drugs, 1
of these chemical enzymes
that will help us fight off the
we've got a true winning combination.
Because these chemicals bind
with the Beta-lactamase
and prevent the enzyme from
enacting the penicillin.
Okay. So, let that sink in.
All we have to do is take the penicillins,
combine them with one of these,
and they will inhibit Beta-lactamases.
Now the odds are in our favor
and the drug is going to be
much more effective.
So, I want to give you a couple examples
of what these winning combinations are.
Now, winning combinations is
a lot easier to say than
That is their official name, but that's,
frankly, annoying to try and
say all that at one time.
But if we take ampicillin
plus sulbactam --
Now you see that -- that's what
we're putting together,
underneath it, you'll see ampicillin/sulbactam.
The trade name is usually called Unasyn.
We've got amoxicillin and clavulanic acid.
We can do to ticarcillin and
clavulanic acid, cool.
Or we can do piperacillin/tazobactam.
The point we want you to
take away from this is
when we put penicillin and
these drugs with it,
we end up with drugs that are now
resistant to Beta-lactamases,
so you'll see these drugs given together.
Okay, now, why do we give penicillins?
Well, we use it to treat infections
caused by bacteria
that are predominantly gram-positive.
Remember gram-positive stains purple.
They're the kinder, gentler bugs
in our other video?
We compared them to Forrest Gump, right?
They weren't as sinister as the gram-negative.
So, gram-negative have active levels
of these weird transpeptidase.
Don't worry about that. Just keep in mind
that penicillins treat gram-
like streptococcus or enterococcus.
So that's what we use them -- the therapeutic
indication for using a penicillin
would be a gram-positive, kinder,
gentler kind of infection.
Gram-negative bacteria are really
not sensitive to penicillin.
They are resistant to penicillins.
So when you're thinking of penicillins,
think of positive bacteria.