β‐Lactam antibiotics are one of the best established classes of antimicrobial agents for the treatment of infectious diseases. By screening strains of bacteria that were specifically responsive to β‐lactam antibiotics, monocyclic β‐lactams, ie, monobactams, varying in substitution at the C‐3 position, were identified. The naturally occurring monobactams include SQ 26,180 (
), SQ 26,445 (C
12
H
20
N
4
O
9
S), sulfazecin (C
12
H
20
N
4
O
9
S), and isosulfazecin (C
12
H
20
N
4
O
9
S). More recently, the 4β‐methyl analogue of SQ 26,445/sulfazecin was isolated using a differential antibacterial assay. Initial syntheses employed the sulfonation of an N‐1 unsubstituted azetidinone as the key step. The natural product SQ, 26,180 as well as other methoxylated monobactams were synthesized. Subsequently, many more C‐3 side‐chain analogues were prepared. A second, distinct chiral synthesis of monobactams was developed from β‐hydroxy amino acids. The methodology was also applied to the synthesis of 4α‐ and 4β‐methyl monobactams. The monobactams, like penicillins and cephalosporins, interfere with the synthesis of bacterial cell walls. B‐Lactam antibiotics bind to a series of penicillin‐binding proteins (PBPs) on the cytoplasmic membrane and their antibacterial effect is believed to result from inhibition of a subset of these PBPs known as peptidoglycan transpeptidases. Although naturally occurring monobactams have exhibited poor antibacterial activity, alteration of the C‐3 amide side chain has led to many potent new compounds. Aztreonam is a totally synthetic compound that exhibits potent and specific activity against a wide range of both β‐lactamase‐producing and nonproducing aerobic gram‐negative bacteria, including
Pseudomonas aeruginosa
, but displays minimal inhibition against anaerobic and gram‐positive aerobic bacteria, eg, staphylococci and streptococci. Two monobactams were in clinical use as of 1990. Aztreonam, manufactured by Bristol‐Myers Squibb, has the worldwide trademark of Azactam. Carumonam, manufactured by Takeda in Japan, has the trademark Amasulin.