MICs of a newly developed benzoxazinorifamycin derivative, KRM-1648, for Mycobacterium avium complex (MAC) were determined by the BACTEC 460 TB system and compared with those of other known antimicrobial agents. The radiometric method gave a fast, accurate, and reproducible MIC for each antimicrobial agent. MICs of KRM-1648 for 30 strains of MAC (10 strains each of M. avium isolated from AIDS and non-AIDS patients and of Mycobacterium intracelulare isolated from non-AIDS patients) were measured. The MICs, ranging from 0.004 to 0.0625 tig/ml, were the lowest of all tested drugs, including rifampin, rifabutin, streptomycin, kanamycin, isoniazid, ethambutol, ofloxacin, ciprofloxacin, sparfloxacin, and clarithromycin. The MICs were 2 to 512 and 1 to 32 times lower than those of rifampin and rifabutin, respectively. With rifampin and ethambutol, there were some differences between the MICs for M. avium isolated from AIDS patients (American) and those forM. avium from non-AIDS patients (Japanese). Moreover, appreciable differences between the MICs of some drugs against M. avium and M. intracelulare isolated from non-AIDS patients were found. Many strains of M. avium were more susceptible to ofloxacin than M. intracelulare, but, conversely, M. avium was more resistant to rifampin, streptomycin, ethambutol, and clarithromycin than M. intracelulare.The standard method in Japan for determination of mycobacterial susceptibility to antimicrobial agents by using 1% Ogawa egg medium requires at least 4 weeks, and chemotherapy cannot be initiated in patients until this time. However, the newly developed BACTEC 460 TB system (3, 5, 9) has made it possible to determine drug susceptibility within 1 week (6,8,10,13). Previously, 3'-hydroxy-5'-(4-isobutyl-1-piperazinyl)benzoxazinorifamycin (KRM-1648; KANEKA Corporation, Hyogo, Japan) demonstrated excellent in vitro activity against slowly growing mycobacteria, especially Mycobacterium avium complex (MAC), in our experiment to determine its MICs for various mycobacterial strains by the agar dilution method using Middlebrook 7H11 agar plates (7). KRM-1648 also exhibited excellent therapeutic efficacy against MAC infections induced in BALB/c and NK-deficient beige mice (12) and in rabbits (unpublished observation) and also demonstrated potent therapeutic activity against M. marinum infection induced in BALB/c mice (14). The MICs of KRM-1648 for various MAC strains isolated from AIDS and non-AIDS patients were determined by using the BACTEC 460 TB system by the method of Heifets et al. (1, 2, 4).
MATERIALS AND METHODSAntimicrobial agents. KRM-1648, rifampin (RMP) (Daiichi Pharmaceutical Co., Tokyo, Japan), rifabutin (RBT) (Farmitalia Carlo Erba Co, Milan, Italy), and clarithromycin (CAM) (Taisho Pharmaceutical Co., Tokyo, Japan) were dissolved in dimethyl sulfoxide. Ofloxacin (OFLX) (Daiichi Pharmaceutical Co.), ciprofloxacin (CPFX) (Bayer Pharmaceutical Co., Osaka, Japan), and sparfloxacin (SPFX) (Dainippon Pharmaceutical Co., Osaka, Japan) were dissolved in * Corresponding author. 0....