The MICs and MBCs of the new difluorinated quinolone drug sparfloxacin against type strains belonging to 21 species of mycobacteria were screened. The MICs and MBCs were within the range of 0.1 to 2.0 and 0.1 to 4.0 ,ug/ml, respectively (with an MBC/MIC ratio of 1 to 2), and against 18 of the 21 species tested, the drug showed significant bactericidal activity (at least 99% killing or more of the initial inoculum added) at concentrations well within the reported peak concentrations in serum (Cm.) in humans. MICs of sparfloxacin for 7 of 10 Mycobacterium avium complex strains were below the Cm,,, with MBC/IMIC ratios within the range of 2 to 4. Enhancement of its activity by ethambutol, rifampin, amikacin, and clarithromycin (which were used at sublethal concentrations) assessed by using BACTEC radiometry revealed that its activity was further enhanced in 2 of 10 strains by rifampin and in 7 of 10 strains by ethambutol. The bactericidal effects of various drugs used alone as well as two-drug combinations used at Cm.. levels were also screened against four strains of M. avium complex growing intracellularly in two different macrophage systems, namely, mouse bone marrow-derived macrophages and peripheral blood monocyte-derived human macrophages. Our results showed a satisfactory correlation between the extracellular and intracellular drug activity data.Recently, newer fluoroquinolones have been reported to have broad antimicrobial spectra, including mycobacteria (3,14,25). Both the N-cyclopropyl analog ciprofloxacin and the tricyclic compound ofloxacin were found to penetrate actively and concentrate inside mammalian cells (6,13,35), and were found to be capable of killing intracellularly growing tubercle bacilli (19). A newly synthesized difluorinated quinolone, sparfloxacin [5 amino-1-cyclopropyl-6,8-difluoro-1,4-dihydro-(7 cis-3,5-dimethyl-1-piperazinyl)-4-oxoquinolone-3-carboxylic acid], was retained for this study because it is a broad-spectrum drug with in vitro and in vivo efficacies equal to or better than those of ofloxacin and ciprofloxacin (17), and compared with other fluoroquinolones, it has lower MICs against both tubercle bacilli (24) and the multiple-drug-resistant opportunistic pathogens belonging to the Mycobacterium avium complex (MAC) (37). Considering the intracellular parasitism of MAC organisms as well as that of other difficult-to-treat atypical mycobacteria, it was interesting that sparfloxacin attained levels in mouse and rat tissues which were 1 to 11 times higher than its concentrations in plasma (maximum concentration in serum [Cmax], 1.4 ,ug/ml) (16).After we made the observations described above, we decided to perform the present four-point study on sparfloxacin activity (i) to assess its antimycobacterial spectrum against 21 species of mycobacteria by MIC and MBC determinations with 7H9 broth; (ii) by radiometric determination of its MICs and MBCs against 10 MAC strains; (iii) to investigate the enhancement of its action (used at a sublethal concentration of 0.25 ,ug/ml) against 10 M...