amikacin + fosfomycin + meropenem

Amikacin + fosfomycin + meropenem is a combination of three antibiotics used primarily in research and clinical practice for the treatment of severe infections caused by multidrug-resistant Gram-negative bacteria, particularly carbapenemase-producing Klebsiella pneumoniae and other Enterobacteriaceae. - **Amikacin** is an aminoglycoside antibiotic that binds to the 30S ribosomal subunit, inhibiting protein synthesis and causing bacterial cell death. - **Fosfomycin** inhibits bacterial cell wall synthesis by blocking the enzyme MurA (UDP-N-acetylglucosamine enolpyruvyl transferase), which catalyzes an early step in peptidoglycan biosynthesis. - **Meropenem** is a carbapenem β-lactam antibiotic that inhibits penicillin-binding proteins (PBPs), disrupting cell wall synthesis. The combination has been studied for its synergistic effects against highly resistant pathogens. In vitro studies have shown that combinations such as fosfomycin with meropenem or amikacin can exhibit significant synergy, leading to enhanced bactericidal activity compared to monotherapy[1][3][4][5]. This triple combination may be considered in life-threatening infections where options are limited due to resistance.