aztreonam + meropenem + vaborbactam

Aztreonam + meropenem + vaborbactam is a combination of three agents used as an investigational or off-label regimen for the treatment of severe infections caused by multidrug-resistant Gram-negative bacteria, particularly those producing metallo-beta-lactamases (MBLs) such as NDM and co-producing serine beta-lactamases like KPC. Aztreonam is a monobactam beta-lactam antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding protein 3 (PBP3), leading to cell lysis. It is unique among beta-lactams in its resistance to hydrolysis by MBLs but can be hydrolyzed by serine carbapenemases such as KPC. Meropenem is a broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis via binding multiple PBPs, but it is inactivated by both MBLs and some serine beta-lactamases. Vaborbactam is a cyclic boronic acid-based non-beta-lactamic inhibitor of class A and C serine beta-lactamases, including KPC; it protects meropenem from degradation but does not inhibit MBLs directly. The rationale for combining these drugs lies in their complementary mechanisms: aztreonam remains active against MBL producers, while the addition of meropenem-vaborbactam helps inhibit co-produced serine β-lactamses that would otherwise degrade aztreonam, thus restoring its activity against highly resistant strains. This triple combination has shown synergistic bactericidal effects in vitro and has been used clinically for life-threatening infections due to organisms resistant to other available therapies[1][2][3][6].

Brand names

Azactam (aztreonam)Cayston (aztreonam)Vabomere (meropenem + vaborbactam)

Other names

ATM + MEVMEV/ATM