Kill kinetics and MICs of finafloxacin and ciprofloxacin against 34 strains with defined resistance mechanisms grown in cation-adjusted Mueller-Hinton broth (CAMHB) at pH values of 7.2 and 5.8 and in synthetic urine at pH 5.8 were determined. In general, finafloxacin gained activity at low pH values in CAMHB and remained almost unchanged in artificial urine. Ciprofloxacin MICs increased and bactericidal activity decreased strain dependently in acidic CAMHB and particularly in artificial urine.Bacteria colonizing or infecting a host grow under hostile conditions, sense changing environmental stress via diverse quorum sensing, and other two-component systems, and respond by up-or downregulating the expression levels of appropriate proteins, which in turn can affect the susceptibility of the cell to antibiotics (2, 11). Examples of environmental stress include, e.g., growth at extreme temperatures, pH, osmotic pressure, and depletion of nutrients, etc.; Escherichia coli and Staphylococcus aureus causing uncomplicated cystitis or growing in urine or in biofilms on indwelling urethral catheters are such examples (3,8,24,28,31,34,35,38).Thus, it is physiologically relevant and clinically important to study the antibacterial activities of agents under test conditions which mimic the infectious focus most closely. Therefore, we used cation-adjusted Mueller-Hinton broth (CAMHB), pH 7.2 and pH 5.8 (Oxoid GmbH, Wesel, Germany), and synthetic urine, pH 5.8, containing 11 solutes each, in concentrations found in a 24-h period in the urine of healthy men (14) for the comparison of the bacteriostatic and -cidal activities of finafloxacin (batch CBC000288) and ciprofloxacin (batch CBC000290).(Part of the data presented in this paper were shown as a poster at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, October 2008.)Thirty-four phenotyped and/or genotyped strains were used for the examination of MICs and kill kinetics, according to CLSI guidelines (6,7,19). S. aureus ATCC 29213, E. coli ATCC 25922, and Enterococcus faecalis ATCC 29212, as well as moxifloxacin as an external standard, served as controls. Tests were run in duplicate; the higher values were reported in case of deviation (1.2%). Kill kinetics were examined by using finafloxacin and ciprofloxacin at bioequivalent concentrations of 16ϫ, 4ϫ, and 1ϫ the individual MIC values, as measured in the corresponding media. Samples for determination of viable counts were taken at 0, 1, 2, 4, 6, 8, and 24 h. Drug carryover was minimized first by dilution and second by plating the aliquots on cation-enriched agar, thus inactivating the fluoroquinolones. In order to quantify the reduction of viable counts and the speed of kill, the times needed to reduce the inocula by 3-log 10 titers and kill rates were calculated as described recently (32). Furthermore, kill rates were normalized to a drug exposure of 1 mg/liter, as the drug concentration/isolate/media and pH associations vary considerably under the different growth conditions studie...