The levels of TMC207 (R207910) that can be reached in mouse organs and the sputa of treated patients easily exceed the MIC of the compound and can therefore interfere with in vitro bacterial titrations. We studied the usefulness of protein-enriched media for the prevention of such drug carryover effects. The average MIC of Mycobacterium tuberculosis was determined on three different media: unsupplemented 7H11 agar (MIC ؍ 0.03 g/ml), 7H11 agar supplemented with 5% bovine serum albumin (BSA; MIC ؍ 1 g/ml), and LowensteinJensen medium (MIC ؍ 14.33 g/ml). In a second stage of the study, the maximal noninhibitory concentrations (MNICs) of TMC207 were determined by adding TMC207 to the bacterial inoculum rather than to the culture medium. These MNICs were 0.97 g/ml for 7H11 agar, 32.33 g/ml for 7H11 agar with 5% BSA, and 96.33 g/ml for Lowenstein-Jensen medium. Both protein-enriched media were able to prevent drug carryover effects, but the use of 7H11 medium supplemented with 5% BSA is preferred for practical reasons.The drug carryover phenomenon can be defined as the inhibition of bacterial growth in vitro which is not due to the inhibition of growth in vivo but, rather, to the presence of high inhibitor concentrations in the tested samples. Failure to recognize the contribution of drug carryover may result in overestimation of a drug's in vivo efficacy. Antibiotics combining high levels of tissue penetration (high volumes of distribution) with low MICs, such as the diarylquinoline TMC207, the nitrodihydro-imidazo-oxazole OPC-67683, the nitroimidazo-oxazine PA-824, and the pyrrole LL-3858 (8), are at risk of displaying the carryover phenomenon when sputum from treated patients or organs from treated animals are cultivated for the isolation of Mycobacterium tuberculosis.TMC207 (also known as R207910) is being assessed in a phase IIb, placebo-controlled, double-blind, randomized trial for the evaluation of its antibacterial activity in subjects with smear-positive pulmonary infection caused by multidrug-resistant M. tuberculosis. Patients are treated for either 2 or 6 months with TMC207 in combination with a background regimen recommended for use for the treatment of multidrugresistant M. tuberculosis infections (a combination of secondline drugs, such as kanamycin, pyrazinamide, ofloxacin, and ethionamide).Following repeated oral administration of TMC207 to the mouse, rat, and dog, the tissue trough levels in all species are high in the lung, spleen, lymph nodes, and thymus, with an average tissue concentration/plasma concentration ratio above 30 (1). Theoretically, concentrations of 10 to 15 g/ml or higher could be achieved in the sputum after several months of treatment with TMC207, and these concentrations exceed the MIC of TMC207 against M. tuberculosis by Ͼ100-fold.When TMC207 was assessed in vitro by equilibrium dialysis, TMC207 was found to be extensively bound to plasma proteins, resulting in a free fraction in the buffer compartment below the quantification limit of the liquid chromatographytandem mass...