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Ceftriaxone + sulbactam + EDTA (commonly abbreviated as CSE) is a fixed-dose combination of three agents designed to combat multidrug-resistant (MDR) gram-negative bacterial infections. Ceftriaxone is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. Sulbactam acts as a beta-lactamase inhibitor, protecting ceftriaxone from degradation by extended-spectrum beta-lactamases (ESBLs). EDTA (ethylenediaminetetraacetic acid), an antibiotic resistance breaker and non-antibiotic adjuvant, chelates divalent metal ions such as zinc and calcium that are essential for the activity of metallo-beta-lactamases (MBLs) and efflux pumps in bacteria. This triple combination extends the spectrum of activity to include ESBL- and MBL-producing bacteria, disrupts biofilms, increases membrane permeability, reduces efflux pump function, and inhibits curli formation. The drug has been approved by the Drug Controller General of India for treatment of complicated urinary tract infections caused by MDR pathogens[1][3][4][5][6]. It has undergone Phase 3 clinical trials for this indication.
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