Subinhibitory concentrations of bacitracin, vancomycin and other inhibitors of cell wall synthesis reversed to varying extents the intrinsic resistance of Mycobacterium tuberculosis to clarithromycin. Ethambutol reversed clarithromycin resistance in all of the M. tuberculosis strains studied regardless of their susceptibility to this drug.

D-Cycloserine (DCS) is a peptidoglycan inhibitor. Although very effective against Mycobacterium tuberculosis, it is seldom employed in the management of this infection due to its high toxicity. β-Chloro-d-alanine (another peptidoglycan inhibitor) reduces the MIC of DCS from 50 to 2.5 mg/L at a concentration significantly below its MIC for this organism. A reduction in bacterial viability and significant growth inhibition (as quantified by the X/Y quotient for the Bactec radiometric procedure) were observed with subinhibitory concentrations of both drugs. It is suggested that this powerful synergic effect should be the object of in vivo and eventually clinical trials.

In mycobacteria, the study of inhibition by metal ions has been limited by the absence of suitable molecular vectors. Recently, we reported on the inhibitory activity of a family of chelators, macrocyclic compounds (MCC), against Mycobacterium tuberculosis. In this study equimolar concentrations of the free cations vanadium(IV), arsenic(III), iron(III), indium(III) and bismuth(III), and as 1:1 complexes with the MCC 1,4,8,11-tetraazacyclotetradecane-1,4,8,11-tetra-acetic acid (TETA) were tested in vitro against M. tuberculosis using the Bactec 460 TB radiometric technology (Becton-Dickinson, MD, USA). Radiometric inhibition above 80% was obtained with free indium(III) and bismuth(III), and ranged from 80% to 99%, with the complexes of TETA with vanadium(IV), bismuth(III) and indium(III), in the order of increasing activity. The highest radiometric inhibition levels were obtained with the [In(TETA)]- complex, which caused drops of up to 4 log units in cellular viability. The minimal inhibitory concentration of this compound was evaluated at 3 microM.