Ertapenem + Vancomycin

Ertapenem + vancomycin is a combination antibiotic therapy that pairs two different classes of antibiotics with complementary mechanisms of action.\ \ Ertapenem is a 1-β methyl-carbapenem antibiotic with a broad spectrum of activity against many Gram-positive and Gram-negative aerobic and anaerobic bacteria. It works by inhibiting cell wall synthesis through binding to penicillin binding proteins (PBPs), particularly PBPs 2 and 3 in Escherichia coli[8].\ \ Vancomycin is a glycopeptide antibiotic often reserved as a "drug of last resort." It acts by binding to the acyl-D-ala-D-ala portion of the growing peptidoglycan cell wall in Gram-positive bacteria, preventing the formation of cross-links necessary for cell wall strength[6]. This binding inhibits cell wall biosynthesis by preventing incorporation of N-acetylmuramic acid (NAM) and N-acetylglucosamine (NAG)-peptide subunits into the peptidoglycan matrix[5].\ \ The combination may be used in certain clinical scenarios, particularly for complicated infections where broader coverage is needed or where there is concern for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia[9].