Original subtitles

I'm glad you've been enjoying our tour of beta -lactam antibiotics.

And I can tell you can't wait to get to our next destination.

But let's take a little detour. We've been at this, what, for 20 minutes now?

Anyone else need a beverage?

Look, I know a place.

Now hear me out.

It's a little rough around the edges. I mean, don't get me wrong, it's a great

establishment. This planet has got a great night scene. It's just a little...

Murdery on occasion.

But when you sign up for this tour, I promise to show you the real beta

antibiotics. Not some phony touristy version. So remember, stay right behind

Never look a bounty hunter in the eye.

Never wait for him to shoot first.

I know a guy who can get us in.

Welcome to Amino's Space Cantina.

In this sketch, we're going to be covering the aminopenicillins,

and ampicillin.

as well as two other broad -spectrum penicillins, piperacillin and

Take a look in the sky window, and we can see the same beta -lactam ringed

planet to remind us that we're still dealing with beta -lactam antibiotics.

Also, looming in the distance is the death caucus under construction.

With cell wall structure exposed, to remind us again that the mechanism of

action of all penicillins is to halt peptidoglycan synthesis at the bacterial

cell wall by binding PBPs.

which were the construction workers before.

This kills the cell, so they're bactericidal.

In our tour so far, we have covered penicillin and anti -staphylococcal

penicillins, antibiotics used primarily for gram -positive infections, such as

staph and strep.

And notice around the death caucus, we see clusters and chains of purple space

stations. But let's take a look inside, a kind of gaudy yet tasteful red theme.

That's because aminopenicillins retain the antibacterial spectrum of

penicillins, but also have improved activity against gram -negative bacteria

because of their enhanced ability to penetrate the gram -negative outer

membrane. Because of this, they're considered broad spectrum, and we will

represent this with a prism hanging from the ceiling and causing a cool rainbow

effect. Yep, aminopenicillins are just amped -up penicillins ready to party.

The aminopenicillins amoxicillin and ampicillin have similar spectrums of

activity, but amoxicillin is better absorbed orally.

Amoxicillin will be represented by an ammo box, a recurring theme from Sketchy

Micro, and will emphasize oral bioavailability here with the open mouth

rebel pilot, or smuggler?

Mercenary?

All I know about him is that his name is Hansillin, and it's probably best not

to antagonize him while he's bored.

He looks like the kind of guy that shoots first and asks questions later.

Huntsillin is wearing a red bandana around his neck to remind us that oral

amoxicillin is often used in children to treat strep throats, caused by strep

pyogenes.

Amoxicillin is also given orally to treat sinusitis, otitis, and respiratory

tract infections, often caused by strep species.

All of these are represented here on this shady character in the middle of

kind of secret, okay, okay, probably perfectly legitimate deal with Hans

Also notice that he's plugging his ears.

And he's got some kind of gross and socially awkward goopy stuff dripping

are those head tubes?

Well, amoxicillin is effective in treating otitis media and sinusitis,

caused by strep pneumo, H flu, and moraxella.

Take a look at that chest plate, too.

And notice the dented, rusty lung spots.

Probably from quite a few altercations with smugglers as he tries to reclaim

boss's debts.

Amoxicillin is an option when treating pneumonia because of its activity

strep pneumo and H -flu.

To highlight aminopenicillin's effectiveness against H -flu, in the sky

above, we can see the H -flu plane from Sketchy Micro.

Now an H -flu spaceship.

Notice the H structure in its wings.

Also important to remember is that amoxicillin is part of the triple

H. pylori.

Hansillin is a pilot, of course. A helicopter pilot.

And his helicobacter helicopter is in the hangar behind him.

All alliterations aside, amoxicillin is also an option for treating Lyme

disease, if early stage or in young children.

And Hansillin is more than just a smuggler.

but a mercenary.

His next target, pun intended, is Robin of Ixodes, a recurring symbol

for Lyme disease caused by Borrelia burgdorferi transmitted by the Ixodes

He's a wanted space outlaw, of course. And be sure to check out our Sketchy

Micro Lyme Disease video that features the northeastern Borrelia bow and arrow

tournament.

Okay, why is that alien, rife with streptococcal infections, plugging his

Well, this is a cantina after all. And no cantina is complete without a band.

We've got a guitarist here, hooked up to an amp to remind us of ampicillin.

And his guitar chord looks like IV, representing IV administration.

Because when ampicillin is given IV, it's useful for treating serious

caused by anaerobes.

such as aspiration pneumonia.

Hence the gas mask, our recurring sketchy symbol for anaerobic coverage.

Also, ampicillin treats enterococcus, a resistant bug that causes UTIs and

endocarditis.

Enterococcus was represented by a rock concert in Sketchy Micro.

And next to our guitarist, we've got a drummer, ready to rock, with a purple

double bass drum highlighting the gram -positive diplococcus shape.

of Enterococcus.

Because resistance strains are important, we've made him a little too

metal and he's kicking over one of the amps as he rocks out. This resistance is

due to the production of beta -lactamases.

Listeria, an important cause of meningitis in infants and the elderly,

treated with ampicillin. And notice that our star shredder is wearing our

recurring meningitis space helmet with the red meningitis mohawk.

to symbolize meningitis in young patients.

Right behind him is tonight's set list.

Dearia. Get it?

When a question on an exam points to meningitis, always think of very young

very old patients who might require the addition of ampicillin to their regimen

in order to cover this bug.

Okay, take a look at the bar.

We can see the red gram -negative theme, of course.

But take a look at these taps for fermented galactic libations.

Looks kind of intestine -y.

I just wanted to remind you that the aminopenicillins are effective against

gastrointestinal and urinary tract gram -negative rods, like E. coli, though

they are not likely the first -line drugs, and this is low yield for an

Ampicillin and amoxicillin are beta -lactamide sensitive, just like

Remember those beta -lactamase troopers with the plasmid ring guns from the

penicillin sketch?

Well, here's one now.

A beta -lactamase bouncer.

On the lookout for suspicious characters.

He looks intimidating, I know, but we're on the list. Don't worry.

To combat beta -lactamases, aminopenicillins are often paired with a

-lactamase inhibitor. For example, amoxicillin with clavulinate.

This helps them prevent being cleaved by the beta -lactamases.

If we take a look at the sign out front, it looks like the beta -lactamase

bouncer is making sure that no smuggled ammo is allowed inside.

But clavulinate is inhibiting the beta -lactamase, represented by the

clavulinate clarinet player, who's distracting the beta -lactamase so that

can be smuggled inside.

So as you can see, amoxicillin is paired with clavulinate, also called

Augmentin. Other beta -lactamase inhibitors include Solbactam and

So next to our distracting clarinet player, we'll add in some tambourine

scanning back -to -back.

Ampicillin is often paired with Solbactam, also called Unison.

Always remember the addition of that back tambourine.

The addition of beta -lactamase inhibitors extends the activities of

penicillins so that they're not cleaved by strains of staph aureus, for example.

Now they're really amped up.

So amped up, in fact, that one of our rebel fighters over here is using some

force on this guy's face, if you know what I mean.

He has a hole torn over his upper left abdominal quadrant to represent a

splenia. Asplenic patients are at higher risk for infection from encapsulated

bacteria, such as strep pneumo and H flu, two bugs highlighted in this

Amoxicillin specifically provides good coverage, and it's used as antimicrobial

prophylaxis in very young patients post -splenectomy, and in asplenic patients

with fever.

Notice that the other guy's tooth is flying out.

This is to remind you that amoxicillin is also used as antimicrobial

before dental procedures in patients at high risk for endocarditis.

One more thing to point out. As he's dished the old chin music, we're going

sketch in a red mask falling off of his face.

This is going to be our sketchy symbol for Steven Johnson syndrome.

and it's here to remind you that amino penicillins can cause rash that can

sometimes manifest more seriously as SJS.

As you can see, things get pretty out of hand at Amino's Cantina, and we're

likely to experience a few adverse effects.

Worldwide, amoxicillin clavulinate is one of the most commonly reported causes

of drug -induced liver injury.

Let this little guy with the big liver spot getting trampled on by the Cantina

patrons remind you of this liver injury.

Another thing to remember,

ampicillin and amoxicillin can be associated with skin rashes when

the setting of viral illnesses, such as an acute Epstein -Barr virus infection.

So take a look at the red flashy lights on Epstein's Barr on the far side of the

room. Alright, before we head out of here, we're going to run into two more

extended spectrum penicillins in this sketch.

They're not aminopenicillins. These are the big guns, pipericillin and

ticaricillin. piperacillin because they're rocking the pipes, and

because they're wearing the hip tiger stripes on their jumpsuits.

Just like ampicillin and damoxicillin, these guys are also paired with beta

-lactamase inhibitors, piperacillin with tezobactam, one of our tambourine

players, and ticaracillin with clavulinate, the clarinet player.

Remember that these combinations are used so that they don't get cleaved by

-lactamases.

It's also important to remember their broad spectrum of coverage includes

anaerobes, like those that cause aspiration pneumonia.

Anaerobic coverage will again be represented by these gas masks.

The most important thing you can remember, though, is that they are

against pseudomonas. And here, piperacillin and ticaracillin are wooing

female with the most enigmatic smile in the entire galaxy.

representing Mona Lisa, of course, are a recurring symbol for pseudomonas.

Pseudomonas coverage is important to consider in hospital -acquired

and in patients who are at risk for multi -drug -resistant bacterial

So because of their broad spectrum of action, including activity against

pseudomonas and anaerobes, piptazo and co -tickerclav are used for serious

infections such as hospital -acquired pneumonia,

and impaired treatment of sepsis.

Well, that's it. Let's sum up this sketch.

Aminopenicillins have extended gram -negative coverage compared to

Remember that amoxicillin is good for sinus infections, respiratory tract

infections, and acute otitis media, and that it has coverage for H. pylori and

Lyme disease.

For ampicillin, remember that it's good for that listeria meningitis in young

patients.

For ticaricillin and pipericillin, these are your big guns that have anaerobic

coverage and can also cover pseudomonas.

And all these guys are paired with beta -lactamase inhibitors so that they

aren't cleaved by beta -lactamases.

And I forgot to mention, remember those side effects of penicillins and other

beta -lactams that we covered in the penicillin sketch?

Alright, in our next scene, we recruit the help of some charming yet ruthless

cephalopod.