Bacterial Resistance Penicillinases (Nursing)

00:01 Okay, let's talk about bacterial resistance, and I mean those nasty penicillinases.

00:07 Remember when we talked about the 4 different groups of penicillins? There was penicillinase resistant, penicillinase sensitive, broad-spectrum penicillins, and extended-spectrum penicillins.

00:20 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.

00:32 So, these are bacteria that produce enzymes that inactivate penicillin.

00:38 So, if I give a patient penicillin or other Beta-lactams, they're not effective in treating the infection.

00:46 So if I have some penicillinases, there are some enzymes that are going to make penicillin completely ineffective.

00:54 Okay, so what can we do? Well, they came up with a brilliant solution.

00:59 That's why you see right there the word "winning combinations," and that's what I want you to think about.

01:04 When you see bacterial resistance, you're thinking about penicillinases, I want you to think -- winning combinations because if we put some combinations together with a penicillin, things go much, much better. The odds are now in our favor.

01:21 Thank you, Hunger Games.

01:22 So, the chemicals or drugs that we've developed to inhibit these enzymes are called clavulanic acid, tazobactam, or sulbactam.

01:31 So, if I put 1 of these drugs, 1 of these chemical enzymes that will help us fight off the bacterial penicillinases, we've got a true winning combination.

01:42 Because these chemicals bind with the Beta-lactamase and prevent the enzyme from enacting the penicillin.

01:49 Okay. So, let that sink in.

01:52 All we have to do is take the penicillins, combine them with one of these, and they will inhibit Beta-lactamases.

02:00 Now the odds are in our favor and the drug is going to be much more effective.

02:05 So, I want to give you a couple examples of what these winning combinations are.

02:10 Now, winning combinations is a lot easier to say than Penicillin-beta-lactamase Inhibitor Combination Drugs.

02:18 That is their official name, but that's, frankly, annoying to try and say all that at one time.

02:23 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.

02:33 The trade name is usually called Unasyn.

02:36 We've got amoxicillin and clavulanic acid.

02:39 We can do to ticarcillin and clavulanic acid, cool.

02:43 Or we can do piperacillin/tazobactam.

02:45 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.

03:00 Okay, now, why do we give penicillins? Well, we use it to treat infections caused by bacteria that are predominantly gram-positive.

03:08 Remember gram-positive stains purple.

03:11 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.

03:19 So, gram-negative have active levels of these weird transpeptidase.

03:24 Don't worry about that. Just keep in mind that penicillins treat gram- positive bacteria, like streptococcus or enterococcus.

03:34 So that's what we use them -- the therapeutic indication for using a penicillin would be a gram-positive, kinder, gentler kind of infection.

03:43 Gram-negative bacteria are really not sensitive to penicillin.

03:48 They are resistant to penicillins.

03:50 So when you're thinking of penicillins, think of positive bacteria.