Antibiotic synergy with enterococcal endocarditis experienced a high relapse rate when penicillin G alone was used for treatment and a demonstrably lower relapse rate when streptomycin was combined with penicillin G to combat the infection. Since that time the research community has conducted numerous studies regarding the effects and possibilities of antibiotic combinations. Today, combination therapy is recognized as providing a broad spectrum of antibiotic coverage, effectively fighting polymicrobial infections, minimizing selection for antibiotic resistant strains, lowering dose toxicity where applicable, and in some cases providing synergistic activity. Antibiotic synergy is desirable in a clinic sense for several reasons. At the patient
Β-lactam antibiotic lower "c" values (better binding to PBPs). By definition, all β-lactam antibiotics have a β-lactam ring in their structure. The effectiveness of these antibiotics relies on their ability to reach the PBP intact and their ability to bind to the PBP. Hence, there are two main modes of bacterial resistance to β-lactams: If the bacterium produces the enzyme β-lactamase or the enzyme penicillinase, the enzyme will hydrolyse the β-lactam ring of the antibiotic, rendering the antibiotic ineffective. (An example of such an enzyme is New Delhi metallo-beta-lactamase 1, discovered in 2009.) The genes encoding these enzymes may be inherently present