Staphylococcus aureus, which often causes chronic or relapsing diseases (68), is reported to persist as an opportunistic intracellular organism both in vitro and in vivo (8,10,18,30,31,34,39). Antibiotic treatments should therefore be optimized not only toward the extracellular forms of S. aureus but also toward the intracellular forms of S. aureus to avoid creating a niche where bacteria may persist, cause cell alterations, and possibly, be selected for resistance if they are exposed to subtherapeutic concentrations (1). A large body of literature on the activities of antibiotics against intracellular S. aureus in various cellular models is available (see references 54, 66, 67, and 70 for reviews). Yet, many of these studies yield contradictory results, and we still lack a clear understanding of which parameters are truly critical for the expression of antibiotic activity in the intracellular milieu (11). In a previous study, we measured the activities of selected antibiotics characterized by a fair to high level of cellular accumulation against intracellular S. aureus in a model of unstimulated murine J774 macrophages (57). We observed that cellular accumulation was only partially and nonconsistently predictive of activity. In a subsequent pilot study, performed with human THP-1 macrophages, we also noted that -lactams, which notoriously do not accumulate in cells, actually showed significant activity against intracellular S. aureus when their extracellular concentration was brought to a sufficiently high but still clinically meaningful level (36). This triggered us to broaden and systematize our approach. For this purpose, we selected typical representatives of seven classes of antibiotics with known activities against S. aureus and included in commonly used guidelines for the handling of staphylococcal infections. We concentrated our effort on THP-1 macrophages because these cells present many of the characteristics of human monocytes while forming a homogeneous and reproducible population (6). THP-1 macrophages have been successfully used in various studies aimed at characterizing the interactions between S. aureus and macrophages in a clinical context (19,28,49) and to analyze the potential relationship between the accumulation of antibiotics in cells and intracellular activity (48). In contrast to many other models, however, we explored a large array of extracellular concentrations (including the range observed in the serum of patients receiving conventional doses) and used incubation times up to 24 h. Our purpose, indeed, was to analyze the pharmacodynamic parameters governing the activities of these antibiotics against intra-* Corresponding author. Mailing address: