ABSTRACTMyeloperoxidase (MPO) is reported to selectively bind to bacteria. The present study provides direct evidence of MPO binding selectivity and tests the relationship of selective binding to selective killing. The microbicidal effectiveness of H2O2and of OCl−was compared to that of MPO plus H2O2. Synergistic microbicidal action was investigated by combiningStreptococcus sanguinis, a H2O2-producing microbe showing low MPO binding, with high-MPO-bindingEscherichia coli,Staphylococcus aureus, orPseudomonas aeruginosawithout exogenous H2O2, with and without MPO, and with and without erythrocytes (red blood cells [RBCs]). Selectivity of MPO microbicidal action was conventionally measured as the MPO MIC and minimal bactericidal concentration (MBC) for 82 bacteria includingE. coli,P. aeruginosa,S. aureus,Enterococcus faecalis,Streptococcus pyogenes,Streptococcus agalactiae, and viridans streptococci. Both H2O2and OCl−destroyed RBCs at submicrobicidal concentrations. Nanomolar concentrations of MPO increased H2O2microbicidal action 1,000-fold. Streptococci plus MPO produced potent synergistic microbicidal action against all microbes tested, and RBCs caused only a small decrease in potency without erythrocyte damage. MPO directly killed H2O2-producingS. pyogenesbut was ineffective against non-H2O2-producingE. faecalis. The MPO MICs and MBCs forE. coli,P. aeruginosa, andS. aureuswere significantly lower than those forE. faecalis.The streptococcal studies showed much higher MIC/MBC results, but such testing required lysed horse blood-supplemented medium, thus preventing valid comparison of these results to those for the other microbes.E. faecalisMPO binding is reportedly weak compared to binding ofE. coli,P. aeruginosa, andS. aureusbut strong compared to binding of streptococci. Selective MPO binding results in selective killing.