amikacin + cefepime + fluconazole

This is a combination of three antimicrobial agents—amikacin, cefepime, and fluconazole—used together for the treatment of severe or mixed infections where both bacterial (including resistant Gram-negative and some Gram-positive organisms) and fungal pathogens are suspected or confirmed.

• Amikacin is an aminoglycoside antibiotic effective against a broad range of Gram-negative bacteria, including resistant strains such as Pseudomonas aeruginosa and Acinetobacter baumannii. It acts by binding to the 30S ribosomal subunit, inhibiting protein synthesis in bacteria.
• Cefepime is a fourth-generation cephalosporin beta-lactam antibiotic with activity against both Gram-positive and Gram-negative bacteria, including many that produce beta-lactamases. It inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.
• Fluconazole is a triazole antifungal agent that inhibits fungal cytochrome P450 enzyme 14α-demethylase (CYP51), disrupting ergosterol synthesis required for fungal cell membrane integrity.

This combination may be used empirically in critically ill patients with healthcare-associated infections when there is concern for multidrug-resistant bacteria as well as invasive fungal infection.