meropenem + plazomicin + tigecycline

This is a combination of three antibiotics—meropenem, plazomicin, and tigecycline—used primarily in the management of severe infections caused by multidrug-resistant Gram-negative bacteria, including carbapenem-resistant Enterobacteriaceae (CRE).

• Meropenem is a broad-spectrum carbapenem antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.
• Plazomicin is a next-generation aminoglycoside that binds to the 30S ribosomal subunit, inhibiting protein synthesis; it has been engineered to evade most aminoglycoside-modifying enzymes.
• Tigecycline is a glycylcycline antibiotic related to tetracyclines; it inhibits protein synthesis by binding to the 30S ribosomal subunit.

This triple combination has been studied in clinical trials for serious infections such as bloodstream infections or hospital-acquired/ventilator-associated pneumonia due to CRE. The rationale for combining these agents lies in their complementary mechanisms of action and potential synergistic effects against highly resistant pathogens. Plazomicin-based regimens with adjunctive meropenem or tigecycline have shown promising efficacy and safety profiles compared with colistin-based combinations.