fosfomycin + ofloxacin + rifampicin

This is a combination antibiotic therapy consisting of three agents—fosfomycin, ofloxacin, and rifampicin. Each component has a distinct mechanism of action:

• Fosfomycin is a broad-spectrum bactericidal antibiotic that inhibits bacterial cell wall synthesis by inactivating the enzyme UDP-N-acetylglucosamine enolpyruvyl transferase (MurA), which catalyzes an early step in peptidoglycan biosynthesis.
• Ofloxacin is a fluoroquinolone antibiotic that inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for DNA replication, transcription, repair, and recombination.
• Rifampicin (also known as rifampin) inhibits bacterial DNA-dependent RNA polymerase, thereby suppressing RNA synthesis.

The combination aims to provide broad-spectrum coverage against both Gram-positive and Gram-negative bacteria. Fosfomycin and rifampicin have demonstrated synergistic activity against biofilm-forming bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), particularly in implant-associated infections. Ofloxacin adds further activity against various pathogens due to its fluoroquinolone class properties. This triple combination may be considered for difficult-to-treat or device-related infections where biofilm formation is suspected or confirmed.