ABSTRACTThe comparativein vitroactivity of SMT19969, a novel, narrow-spectrum, nonabsorbable agent, was studied against 50 ribotype-definedClostridium difficilestrains, 174 Gram-positive and 136 Gram-negative intestinal anaerobes, and 40 Gram-positive aerobes. SMT19969 was one dilution more active againstC. difficileisolates (MIC range, 0.125 to 0.5 μg/ml; MIC90, 0.25 μg/ml), including ribotype 027 strains, than fidaxomicin (range, 0.06 to 1 μg/ml; MIC90, 0.5 μg/ml) and two to six dilutions lower than either vancomycin or metronidazole. SMT19969 and fidaxomicin were generally less active against Gram-negative anaerobes, especially theBacteroides fragilisgroup species, than vancomycin and metronidazole, suggesting that SMT19969 has a lesser impact on the normal intestinal microbiota that maintain colonization resistance. SMT19969 showed limited activity against other Gram-positive anaerobes, includingBifidobacteriaspecies,Eggerthella lenta,Finegoldia magna, andPeptostreptococcus anaerobius, with MIC90s of >512, >512, 64, and 64 μg/ml, respectively.Clostridiumspecies showed various levels of susceptibility, withC. innocuumbeing susceptible (MIC90, 1 μg/ml) andC. ramosumandC. perfringensbeing nonsusceptible (MIC90, >512 μg/ml). Activity againstLactobacillusspp. (range, 0.06 to >512 μg/ml; MIC90, >512 μg/ml) was comparable to that of fidaxomicin and varied by species and strain. Gram-positive aerobic cocci (Staphylococcus aureus,Enterococcus faecalis,E. faecium, and streptococci) showed high SMT19969 MIC90values (128 to >512 μg/ml).