Newly synthesized rifamycin derivatives, KRM-1648, KRM-1657, KRM-1668, KRM-1686, and KRM-1687, having the chemical structures of 3'-hydroxy-5'-(4-alkylpiperazinyl)-benzoxazinorifamycins (alkyl residues: isobutyl, propyl, sec-butyl, sec-butyl [R configuration], and sec-butyl [S configuration], respectively), were studied for their in vitro antimycobacterial activities. Representative (KRM-1648) MICs for 90% of the strains tested, determined by the agar dilution method on 7H11 medium, of various pathogenic mycobacteria (9 species, 174 strains) were as follows (in micrograms per milliliter): Mycobacterium tuberculosis (rifampin [RMP]-susceptible strains), <0.0125; M. tuberculosis (RMP-resistant strains), 12.5; M. kansasii, 0.05; M. marinum, .0.0125; M. scrofulaceum, 0.1; M. avium, 1.56; M. intracellulare, 0.1; M. fortuitum, >100; and M. chelonae subsp. abscessus and M. chelonae subsp. chelonae, >100. These values are more than 64 times lower than those of RMP, except for the values against RMP-resistant M. tuberculosis (8 times lower) and those against rapid growers, including M. fortuitum and M. chelonae (the same as those of RMP). The other derivatives had similar levels of in vitro activity against these mycobacteria. When murine peritoneal macrophages in which M. intracellulare was phagocytosed in vitro were cultured in the presence of the benzoxazinorifamycins (1 ,ug/ml), much more rapid killing of the organisms ingested in the macrophages was seen compared with when the same amount of RMP was added to the medium. The addition of benzoxazinorifamycins at the concentration of 0.05 ,ig/ml caused more marked suppression of intracellular growth of the organisms compared with addition of RMP. KRM-1648 and KRM-1657 inhibited intracellular growth of M. tuberculosis, and their efficacies were much greater than that of RMP.Rifampin (RMP), a rifamycin derivative, is highly active against a number of mycobacteria, especially slow growers such as Mycobacterium tuberculosis, M. kansasii, and M. marinum (3,22,23), and is used for the treatment of patients with tuberculosis and some atypical mycobacterial infections (4,8,17,21,27 (4,21,27) because of its considerably weak in vitro activity against the MAC (3, 22, 23), possibly because of the permeability barrier of the organisms (7,20). Although other types of rifamycin derivatives, e.g., rifabutin (RBT) (2), rifapentine (1), FCE22807 (6), CGP40/469A (6), CGP-7040 (10), and P-DEA (10), have been developed and although the drugs have higher in vitro antimycobacterial activities than RMP (2, 3, 5, 9, 23, 28), the drugs are generally not so active against MAC infection in humans, particularly immunocompromised hosts (12,14,29). Since MAC infections are increasing remarkably in immunocompromised hosts, particularly in AIDS patients (30), the need to develop new antimicrobial agents including rifamycin derivatives which have a strong activity against the MAC is urgent. In this study, we described the in vitro activities of newly synthesized benzoxazinorifamycins against various p...