Combination antibiotic

A combination antibiotic is one in which two ingredients are added together for additional therapeutic effect.[1] One or both ingredients may be antibiotics.[1]

Antibiotic combinations are increasingly important because of antimicrobial resistance.[2] This means that individual antibiotics that used to be effective are no longer effective,[1] and because of the absence of new classes of antibiotic, they allow old antibiotics to be continue to be used.[2] In particular, they may be required to treat multiresistant organisms,[1][2] such as carbapenem-resistant Enterobacteriaceae.[3] Some combinations are more likely to result in successful treatment of an infection.[1]

Uses

Antibiotics are used in combination for a number of reasons:

to treat multiresistant organisms,[1][2] such as carbapenem-resistant Enterobacteriaceae.[3]
Amoxicillin/clavulanic acid, which includes the beta lactam amoxicillin with the suicide inhibitor clauvanic acid, which helps the amoxicillin overcome the action of beta lactamase
because a person may be infected with more than one microbe simultaneously,[3] for example infections of the abdominal cavity after bowel perforation.
because antibiotics used together may act synergisticly to increase the efficacy of both,[3]
because antibiotics used together may have a broader spectrum than each antibiotic used individually.[3]

Examples

Examples of combinations include:

Amoxicillin/clavulanic acid, which includes the beta lactam amoxicillin with the suicide inhibitor clauvanic acid, which helps the amoxicillin overcome the action of beta lactamase
Trimethoprim/sulfamethoxazole

Research

Research into combination antibiotics is ongoing.[1]

References

Bassetti, Matteo; Righi, Elda (October 2015). "New antibiotics and antimicrobial combination therapy for the treatment of gram-negative bacterial infections". Current Opinion in Critical Care. 21 (5): 402–411. doi:10.1097/MCC.0000000000000235. PMID 26263298. S2CID 45984482.
Tyers, Mike; Wright, Gerard D. (25 January 2019). "Drug combinations: a strategy to extend the life of antibiotics in the 21st century". Nature Reviews Microbiology. 17 (3): 141–155. doi:10.1038/s41579-018-0141-x. PMID 30683887. S2CID 59259623.
Ahmed, A; Azim, A; Gurjar, M; Baronia, AK (May 2014). "Current concepts in combination antibiotic therapy for critically ill patients". Indian Journal of Critical Care Medicine. 18 (5): 310–4. doi:10.4103/0972-5229.132495. PMC 4047693. PMID 24914260.

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[Bassetti2015-1] Bassetti, Matteo; Righi, Elda (October 2015). "New antibiotics and antimicrobial combination therapy for the treatment of gram-negative bacterial infections". Current Opinion in Critical Care. 21 (5): 402–411. doi:10.1097/MCC.0000000000000235. PMID 26263298. S2CID 45984482.

[Tyres2019-2] Tyers, Mike; Wright, Gerard D. (25 January 2019). "Drug combinations: a strategy to extend the life of antibiotics in the 21st century". Nature Reviews Microbiology. 17 (3): 141–155. doi:10.1038/s41579-018-0141-x. PMID 30683887. S2CID 59259623.

[Ahmed2014-3] Ahmed, A; Azim, A; Gurjar, M; Baronia, AK (May 2014). "Current concepts in combination antibiotic therapy for critically ill patients". Indian Journal of Critical Care Medicine. 18 (5): 310–4. doi:10.4103/0972-5229.132495. PMC 4047693. PMID 24914260.