Sulbactam, lactamase inhibitor preparation

A disadvantage of ampicillin and amoxicillin is that they are inactivated by penicillinase, and more strains of H. influenzae are becoming resistant through penicillinase (p-lactamase) production. The addition of a p-lactamase inhibitor such as clavulanate (clavulanic acid) or sulbactam to a penicillin preparation can protect the penicillin component because these chemicals irreversibly inactivate bacterial P-lactamases. 

The 3-chloromethyl cephalosporin 41 has been used for the preparation of nitrocefin 42 via Finkelstein and Wittig reactions <05JOC367>. The bicyclic P-lactam 43, a simple C3 homologue of sulbactam, has been prepared and evaluated as an improved inhibitor of class C P-lactamases <05JOC4510>. 

Use of compounds which inhibit the enzyme P-lactamase, for example, the synthetically prepared sulbactam 1 [371]. The most successful method is the combination of a semisynthetic penicillin with a P-lactamase inhibitor. There is a seemingly endless conflict between chemists, continually synthesizing new compounds, and bacteria, constantly developing new mechanisms of resistance. 

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