In Vitro Activities of Two Ketolides, HMR 3647 and HMR 3004, against Gram-Positive Bacteria

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Abstract
The in vitro activities of two new ketolides, HMR 3647 and HMR 3004, were tested by the agar dilution method against 280 strains of gram-positive bacteria with different antibiotic susceptibility profiles, including Staphylococcus aureus , Enterococcus faecalis , Enterococcus faecium , Streptococcus spp. (group A streptococci, group B streptococci, Streptococcus pneumoniae , and alpha-hemolytic streptococci). Seventeen erythromycin-susceptible (Em s ), methicillin-susceptible S. aureus strains were found to have HMR 3647 and HMR 3004 MICs 4- to 16-fold lower than those of erythromycin (MIC at which 50% of isolates were inhibited [MIC 50 ] [HMR 3647 and HMR 3004], 0.03 μg/ml; range, 0.03 to 0.06 μg/ml; MIC 50 [erythromycin], 0.25 μg/ml; range, 0.25 to 0.5 μg/ml). All methicillin-resistant S. aureus strains tested were resistant to erythromycin and had HMR 3647 and HMR 3004 MICs of >64 μg/ml. The ketolides were slightly more active against E. faecalis than against E. faecium , and MICs for individual strains varied with erythromycin susceptibility. The MIC 50 s of HMR 3647 and HMR 3004 against Em s enterococci (MIC ≤ 0.5 μg/ml) and those enterococcal isolates with erythromycin MICs of 1 to 16 μg/ml were 0.015 μg/ml. E. faecalis strains that had erythromycin MICs of 128 to >512 μg/ml showed HMR 3647 MICs in the range of 0.03 to 16 μg/ml and HMR 3004 MICs in the range of 0.03 to 64 μg/ml. In the group of E. faecium strains for which MICs of erythromycin were ≥512 μg/ml, MICs of both ketolides were in the range of 1 to 64 μg/ml, with almost all isolates showing ketolide MICs of ≤16 μg/ml. The ketolides were also more active than erythromycin against group A streptococci, group B streptococci, S. pneumoniae , rhodococci, leuconostocs, pediococci, lactobacilli, and diphtheroids. Time-kill studies showed bactericidal activity against one strain of S. aureus among the four strains tested. The increased activity of ketolides against gram-positive bacteria suggests that further study of these agents for possible efficacy against infections caused by these bacteria is warranted.

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