The present study was performed to compare the antibacterial activities of kanamycin and gentamicin on Staphylococcus aureus phagocytosed by human monocytes and on nonphagocytosed S. aureus. The method used permitted the measurement of the effect of antibiotics on intracellular bacteria independent of phagocytosis and intracellular killing by the monocytes. A morphological assay with lysostaphin established the intracellular localization of about 70% of the cell-associated S, aureus in the monocyte-bacterium suspension. After 1 h of incubation, the antibacterial activity of both aminoglycosides was greater against intracellular than against nonphagocytosed S. aureus, but after 3 h, the reverse was true. The maximal effect on phagocytosed S. aureus, i.e., killing of about 98% of the bacteria, was reached in the first hour of incubation at kanamycin and gentamicin concentrations of 5 and 1 ,uglml, respectively. A cell-free medium in which monocytes had been incubated increased the antibacterial activity of kanamycin, indicating that monocytes secrete a factor that enhances the antibacterial activity of aminoglycosides.Host defense mechanisms and antimicrobial therapy together determine the outcome of an infection. A well-known, albeit negative, example of this is the diminished efficacy of aminoglycosides in granulocytopenic patients (3, 17). Interactions, whether negative or positive, between antimicrobial drugs and the host defense system, in which phagocytic cells play an important role, may be of great clinical importance. For the sake of brevity, the extensive literature on the interactions between aminoglycosides and phagocytic cells will not be discussed here.Recently, we showed that human monocytes enhance the antibacterial effect of penicillins on extracellular Staphylococcus aureus (18) and presented evidence that penicillins are active against S. aureus phagocytosed by monocytes (17a). These observations raised the question of whether the same was the case for aminoglycosides, and the present study was performed to investigate the influence of human monocytes on the antibacterial activity of aminoglycosides against S. aureus. The assay used permitted the measurement of the effect of aminoglycosides on intracellular S. aureus independent of phagocytosis and intracellular killing by the monocytes (20 was considered to be active if 99.5% of the bacteria were killed during this incubation.Serum. Blood from healthy type-AB blood donors was allowed to clot at room temperature, after which serum was prepared by centrifugation for 20 min at 1,100 x g. Serum was stored at -70°C.S. aureus. A kanamycin-and gentamicin-susceptible strain of S. aureus (type 42D) and a kanamycin-arnd gentamicinresistant strain of S. aureus (clinical isolate obtained from