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Rationale: Extensively drug resistant Klebsiella pneumoniae is defined as resistant to least one antimicrobial agent in all but two or lesser antimicrobial categories. Patient concerns: A 58-year-old diabetic male was admitted with bilateral pneumonia. Sputum culture grew Klebsiella pneumoniae which was sensitive to only colistin on culture. Diagnosis: Acute hypoxemic respiratory failure causes bilateral pneumonia (community acquired). Intervention: The combination therapy of oral faropenem and intravenous colistin for treatment. Outcome: The patient recovered fully and is doing well on follow-up. Lesson: Emerging antibiotic-resistant and hypervirulent strains of Klebsiella pneumoniae should drive further studies on novel antibiotic combinations for extensively drug-resistant Klebsiella pneumonia.