We examined 100 clinically significant isolates of Serratia marcescens for susceptibility to newer cephalosporin and cephamycin antibiotics, alone and in combination with various aminoglycosides. Moxalactam and cefotaxime were the most effective agents; all isolates were inhibited by 25 and 50 ,ug/ml, respectively. All strains were susceptible to amikacin at concentrations safely achievable in serum, whereas gentamicin, netilmicin, and tobramycin inhibited 63, 63, and 16% of the isolates, respectively. Moxalactam, cefotaxime, and amikacin were active against gentamicin-susceptible and gentamicin-resistant strains. Studies of synergy revealed that moxalactam and cefotaxime, in combination with netilmicin or amikacin, were often synergistic and infrequently antagonistic against cephalothin-and gentamicin-resistant strains. These results suggest that moxalactam and cefotaxime, alone or in combination, may be efficacious in treating infections due to multiply antibiotic-resistant S. marcescens.Over the past decade, Serratia marcescens has achieved preeminence as a cause of serious nosocomial infections (6,21,23,30). Susceptibility to aminoglycoside antibiotics was, at one time, taken for granted, but the emergence of multiply antibiotic-resistant strains has been a cause for concern (23,30).Cephalosporin antibiotics have been notoriously ineffective against S. marcescens. However, newer generations of cephalosporins, most notably moxalactam (LY127935) and cefotaxime (HR756), have been shown to be extremely active in vitro against both cephalothin-susceptible and cephalothin-resistant strains and some gentamicin-resistant organisms (7,8,10,13,24,27 Only strains judged to be involved in clinically significant infections were studied, including: (i) urinary isolates (36 strains) at more than 100,000 organisms per ml of urine on two consecutive daily urine cultures; (ii) wound isolates (21 strains) when S. marcescens was the only organism cultured from an infected area; (iii) sputum isolates (23 strains) when S. marcescens was consistently isolated in pure culture from a patient with purulent sputum, fever, and pulmonary infiltrates; (iv) blood (17 strains