Despite the availability of numerous antistaphylococcal drugs, the treatment of severe staphylococcal infections remains a major therapeutic challenge. A new class of antimicrobial agents, the fluoroquinolones, is under development. These drugs are consistently active against both methicillin-or oxacillin-susceptible (OS) and methicillin-or oxacillin-resistant (OR) staphylococci (2,8,9,20,26). In this study, we compared the in vitro antistaphylococcal activity of one fluoroquinolone, pefloxacin, alone and in combination with other drugs, with the antistaphylococcal activities of other drugs and drug combinations.MATERIALS AND METHODS Organisms. Staphylococci were clinical isolates identified by using a profile of 27 biochemical tests and the interpretive criteria of Kloos and Schleifer (13). Included were 50 strains each of Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus haemolyticus and 25 strains each of Staphylococcus hominis and Staphylococcus saprophyticus. Half of the S. aureus, S. epidermidis, and S. haemolyticus strains and all of the S. hominis and S. saprophyticus strains were OS; the others were OR.MICs. Laboratory standards of oxacillin, cephalothin, pefloxacin, vancomycin, gentamicin, erythromycin, clindamycin, doxycycline, and trimethoprim-sulfamethoxazole were supplied by the manufacturers, diluted according to instructions, and dispensed into microdilution plates using an MIC-2000 Plus dispensing machine (Dynatech Laboratories, Inc., Alexandria, Va.) in log2 dilution steps within the range of 0.06 to 64 ,ug/ml. MICs were determined by a standardized microdilution method (18) in 0.1-ml volumes of cation-supplemented Mueller-Hinton broth (Difco Laboratories, Detroit, Mich.). For oxacillin and cephalothin, 2% NaCl was added to the medium (18). Trimethoprimsulfamethoxazole was tested in a fixed 1:19 ratio; 0.1 U of thymidine phosphorylase (Burroughs Wellcome Co., Re-* Corresponding author. search Triangle Park, N.C.) per ml was added. The final inoculum was ca. 5 x 105 CFU/ml. The trays were incubated at 35°C. MIC endpoints were determined at 18 h; oxacillin susceptibility or resistance was determined by using appropriate breakpoints for the various species tested (9).To screen for synergy or antagonism, MICs were determined for 10 strains each of OS S. aureus, OR S. aureus, OS S. epidermidis, OR S. epidermidis, OS S. haemolyticus, and OR S. haemolyticus by using fixed 1:1 (by weight) drug combinations: oxacillin with pefloxacin, gentamicin, or rifampin against OS strains; vancomycin with pefloxacin, gentamicin, or rifampin against OR strains; and pefloxacin with gentamicin or rifampin against all strains.Killing kinetics. Killing-kinetic studies were performed with pefloxacin, oxacillin, vancomycin, rifampin, gentamicin, and various combinations of those drugs with 23 strains of S. aureus, S. epidermidis, and S. haemolyticus. Studies were performed in 50-ml volumes of cationsupplemented Mueller-Hinton broth with an inoculum of ca.106 CFU/ml. Antibiotic concentrations were selec...