The main reason that such agents as clavulanic acid, is added to some proprietary (manufactured) penicillin combination products is to:
|A||Add antibiotic activity against Pseudomonas and many Enterobacter species|
|B||Facilitate antibiotic penetration into the central nervous system and cerebrospinal fluid|
|C||Inhibit cell wall transpeptidase|
|D||Inhibit inactivation of penicillin by -lactamase- producing bacteria|
a. These agents are inhibitors of penicillinase (and are used in conjunction with -lactamase-sensitive penicillins to potentiate their activity.
b. These drugs are found in several brand-name fixed-dose penicillin combination products (amoxicillin and clavulanic acid; sulbactam with ampicillin; tazobactam with piperacillin). Clavulanic acid is an irreversible inhibitor.
c. These agents do not, per se, add activity against Pseudomonas or Enterobacter (an activity already possessed by piperacillin but not by ampicillin or amoxicillin).
d. They have no intrinsic effect to facilitate entry into the CNS or CSF. They do not inhibit hepatic metabolism of the penicillins, and renal excretion (not metabolism) is the main pathway for penicillin elimination.
e. The penicillinase inhibitors have absolutely no impact on the risks or severities of allergic reactions to penicillins.