The reasons why aminoglycosides are bactericidal have not been not fully elucidated, and evidence indicates that the cidal effects are at least partly dependent on iron. We demonstrate that availability of iron markedly affects the susceptibility of the facultative intracellular bacterium Francisella tularensis strain SCHU S4 to the aminoglycoside gentamicin. Specifically, the intracellular depots of iron were inversely correlated to gentamicin susceptibility, whereas the extracellular iron concentrations were directly correlated to the susceptibility. Further proof of the intimate link between iron availability and antibiotic susceptibility were the findings that a ⌬fslA mutant, which is defective for siderophore-dependent uptake of ferric iron, showed enhanced gentamicin susceptibility and that a ⌬feoB mutant, which is defective for uptake of ferrous iron, displayed complete growth arrest in the presence of gentamicin. Based on the aforementioned findings, it was hypothesized that gallium could potentiate the effect of gentamicin, since gallium is sequestered by iron uptake systems. The ferrozine assay demonstrated that the presence of gallium inhibited >70% of the iron uptake. Addition of gentamicin and/or gallium to infected bone marrow-derived macrophages showed that both 100 M gallium and 10 g/ml of gentamicin inhibited intracellular growth of SCHU S4 and that the combined treatment acted synergistically. Moreover, treatment of F. tularensis-infected mice with gentamicin and gallium showed an additive effect. Collectively, the data demonstrate that SCHU S4 is dependent on iron to minimize the effects of gentamicin and that gallium, by inhibiting the iron uptake, potentiates the bactericidal effect of gentamicin in vitro and in vivo.F rancisella tularensis is the etiological agent of the zoonotic disease tularemia. The bacterium has the capability to infect via many different routes, and the most common clinical manifestation is through vector-borne transmission, which leads to ulceroglandular tularemia (1). Another common route is through inhalation, which leads to respiratory tularemia, the most serious form of the disease (1). There are several subspecies of F. tularensis, and of these, the two clinically important forms are F. tularensis subsp. holarctica and F. tularensis subsp. tularensis (2). The latter is the more virulent form, and in the preantibiotic era, the respiratory form had a case-fatality rate of more than 50%. F. tularensis is a facultative intracellular bacterium capable of infecting many forms of cells; however, by far the most studied interaction is between F. tularensis and monocytic cells (3). As for other intracellular bacteria, the uptake of iron is critical for the successful replication, but in this regard F. tularensis is unusual since previous studies have identified only two iron uptake systems; the ferrous iron (feo) and the ferric siderophore (fsl) systems (4). The exact roles and contributions of these systems for efficient intramacrophage replication of the highly virulent...