A mechanistic neural network model predicts both potency and toxicity of antimicrobial combination therapies.

Antimicrobial resistance poses a major global threat due to the diminishing efficacy of current treatments and limited new therapies. Combination therapy with existing drugs offers a promising solution, yet current empirical methods often lead to suboptimal efficacy and inadvertent toxicity. The high cost of experimentally testing numerous combinations underscores the need for data-driven methods to streamline treatment design. We introduce CALMA, an approach that predicts the potency and toxicity of multi-drug combinations in Escherichia coli and Mycobacterium tuberculosis. CALMA identified synergistic antimicrobial combinations involving vancomycin and isoniazid that were antagonistic for toxicity, which were validated using in vitro cell viability assays in human cell lines and through mining of patient health records that showed reduced side effects in patients taking combinations identified by CALMA. By combining mechanistic modelling with deep learning, CALMA improves the interpretability of neural networks, identifies key pathways influencing drug interactions, and prioritizes combinations with enhanced potency and reduced toxicity.