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Anhydrous citric acid + lefamulin refers most specifically to the intravenous **Xenleta** drug product configuration in which **lefamulin** is the antibacterial active ingredient and **anhydrous citric acid** is present in the supplied citrate-buffered diluent/excipient rather than acting as an anti-infective co-active. Lefamulin is a pleuromutilin **small molecule** antibacterial originally developed by Nabriva Therapeutics and later associated with Alvogen commercialization, and it inhibits bacterial protein synthesis by binding to the peptidyl transferase center of the **50S ribosomal subunit**. The product is indicated for treatment of **community-acquired bacterial pneumonia** in adults caused by susceptible organisms, and the IV presentation is best understood as a formulation-level combination/product presentation rather than a two-active-drug therapeutic combination.
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