amikacin + fosfomycin

Amikacin + fosfomycin is a combination of two antibiotics used primarily for the treatment of severe bacterial infections, including neonatal sepsis and infections caused by multidrug-resistant Gram-negative bacteria. Amikacin is an aminoglycoside antibiotic that binds to the bacterial 30S ribosomal subunit, interfering with mRNA binding and tRNA acceptor sites, thereby inhibiting protein synthesis and leading to bacterial cell death[6]. Fosfomycin is a broad-spectrum antibiotic that inhibits the enzyme UDP-N-acetylglucosamine enolpyruvyl transferase (MurA), blocking the first step in bacterial cell wall synthesis[8]. The combination has demonstrated synergistic bactericidal activity, enhanced initial bacterial kill rates, and delayed or reduced emergence of resistance compared to monotherapy with either agent. This regimen has been proposed as an alternative empirical therapy for neonatal sepsis in settings with high antimicrobial resistance rates[1][2][3][5].