cefepime + meropenem + vancomycin

This is a combination of three antibiotics—cefepime, meropenem, and vancomycin—used together as an empirical or targeted therapy for severe, life-threatening infections where multidrug-resistant organisms are suspected or confirmed.

• Cefepime is a fourth-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria. It is particularly effective against Pseudomonas aeruginosa and has high stability toward beta-lactamases.
• Meropenem is a carbapenem antibiotic with very broad-spectrum activity, including many multidrug-resistant Gram-negative organisms. It is often reserved for nosocomial infections at high risk of drug resistance.
• Vancomycin is a glycopeptide antibiotic primarily used to treat serious infections caused by Gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA).

The combination may be considered in critically ill patients (e.g., those with septic shock or central nervous system infections) when the causative organism(s) are unknown and there is concern for both resistant Gram-positive (e.g., MRSA) and highly resistant Gram-negative pathogens. This regimen provides extremely broad coverage but carries increased risks of toxicity such as nephrotoxicity (acute kidney injury), especially when vancomycin and meropenem are combined at high doses.