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Beta-lactam + vancomycin is a combination antibiotic therapy that demonstrates synergistic activity against methicillin-resistant Staphylococcus aureus (MRSA), including vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA) strains. The combination significantly improves antibacterial activity compared to either agent alone. The proposed mechanism for this synergy relates to cell-wall thinning via the beta-lactam, which increases vancomycin binding to target sites during cell wall synthesis. Various beta-lactams have shown synergy with vancomycin, including ceftaroline, cefazolin, cefepime, nafcillin, ampicillin, amoxicillin/clavulanate, piperacillin-tazobactam, cephalexin, cefoxitin, ceftriaxone, ceftazidime, and cefotaxime.
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