hey everybody dr. Rowe here this video we're going to cover the carbapenems and the mono back dams with a one mono vacuum so the reason I group them together is honestly mono back them isn't that important I mean we need to talk about it but we're gonna spend almost all of our time talking about the carbapenems and I'll explain why in just a little bit so you see why they're related they're both beta-lactam antibiotics just like the penicillins and the cephalosporins we've already covered which means they have that beta-lactam ring that same penicillin nucleus basically then they have their different side groups in different structure which makes them behave differently so as far as the the only important mono back dam really the only one that's used is Astraea NAMM which is called exact dam I believe it is narrow spectrum and I'd say the reason that this is still very important and worth noting here is it's effective against Pseudomonas so one thing one you know suitum will talk about the drug-resistant organisms in future series but Pseudomonas is one of the really most terrifying ones when I think of like these nightmare bacteria Pseudomonas comes to mind like in the lab when we're testing the effectiveness of antibiotics I always have the students tested against Pseudomonas because I want to see how it works right so it's it's relatively important but let's talk about the carbapenems so there's there are a variety of different semi-synthetic carbapenems you've got imipenem as the one we'll talk about the most Mira Penniman and dorapin M so these are very broad spectrum which means they've been used a lot right so one of the one of the ways that antibiotics have been used and you could argue misused is the more broad-spectrum antibiotic is the more likely it was to be used especially early if you don't know what someone has you would do kind of a shotgun approach so the good news and bad news about broad-spectrum antibiotics right they can be useful but that means you're going to be using them so often and exposing so many microbes to them and and forcing so many bacteria to a to evolve around them in their presence that you're going to see resistance and this is where we're at you know a pretty pretty scary situation so the carbapenems that you know they're still they're still primarily effective they do have the broadest spectrum of any of the beta-lactam antibiotics we talked about that's a key thing to remember they can still kill some of your gram negatives and they are also resistant to the beta lactamase enzymes that with that that would destroy penicillin pretty easily but here so let me give you an example and we'll talk about the problem so my favorite example is called prime axon so this is going to be an M Opena antibiotic so it has to be injected but then you're gonna add something called Scylla statin to it or Scylla State and some would say the reason you do that is this is an effective antibiotic but it breaks down in the kidneys like uber fast so here you see an example of a combination not of two antibiotics but an antibiotic and a compound that makes it more effective so what so statin does is keeps it in circulation so it can work longer instead of just being instead of being filtered out of the kidneys at this point from axon this imipenem antibiotic is still effective against a you know well over 90% of the the organisms that are isolated from hospitals so this you can see this being a very powerful antibiotic but when I think of antibiotics I think of basically every antibiotic has a counter and every time I use it that number is is getting lower and when it gets to zero the drugs aren't gonna be useful anymore like what happened with methicillin so it's still it's very effective if you're trying to save lives today but the reality is we will reach a point where this antibiotic is not near as effective like three years ago four years ago I would have said this is effective against 98% of organisms in the hospital I think that number is is slowly starting to drop so why does this matter so much well you maybe maybe you've never heard of it but if you go to Google or whatever if you type in nightmare bacteria or if you look at you know some of the biggest concerns that the CDC has when it comes to antibiotic resistance they are going to be DC r-e organisms carbapenem resistant and Theriault bacteria C I'll spell the I'll spell that on the screen has lots of owls right but these the these anterior bacteria see this is a large family of an organism so you're looking at Shigella Klebsiella eco lied Pseudomonas these kind of organisms that group of organisms when they become resistant to carbapenems we're basically like out of antibiotic options are almost out of them because if you if you're carbapenem resistant then you're then you're resistant to the other beta-lactam antibiotics we talked about so these are all superbugs which means they're resistant to more than one type of drug some of these CRE organisms are resistant to every antibiotic we have except for one called coalesced in' which I'll cover in a separate video here's the big concern if the CR organisms which already exist become coalesced and resistant then we will not have an antibody to treat them unless something new comes along the line so we do and we do know that there are some organisms that are resistant to coalesced and so if you take an organism that's resistant to the carbapenems and it learns how to become coalesced and resistant from the organisms that already exist then you might you might truly have a situation where we have microbes where there is no treatment I mean there's already some untreatable strains but we're talking about huge families of an organism's that are antibiotics will work against together anymore so when people are talking about this kind of doomsday scenario like what would the world look like without antibiotics that's what we're talking about CRE organisms that become resistant to their the last lam defense which is a polymyxin he or coulis them so this this is very terrifying at this point if someone gets a CRE infection like in their bloodstream even with treatment half of them are going to die like this this is definitely a big big concern so I'd say the main reason to understand the carbapenems is their significance now but as organisms start to resist them we are we are really really in trouble unless we can come up with new antibiotics or antibiotic alternatives and I I'm an optimist we're going to stay ahead of the situation but this is this is a big concern all right so those these are the LAT the last groups of beta-lactam antibiotics I wanted to cover the mono back dams and then more importantly the carbapenem antibiotics I hope this helps have a wonderful day be blessed