What this test measures
The MACC panel tests Mycobacterium tuberculosis on culture against four important second-line drugs: Moxifloxacin (Mfx, fluoroquinolone), Amikacin (Am, injectable aminoglycoside), Capreomycin or Cycloserine depending on the lab convention, and Clofazimine (Cfz, repurposed leprosy drug now used in all-oral MDR-TB regimens).
Results are reported as sensitive or resistant at WHO critical concentrations. The panel matters because it covers drugs central to modern MDR / pre-XDR / XDR-TB regimens — particularly moxifloxacin and clofazimine, both backbone agents in WHO-endorsed all-oral regimens.
Why it matters
NTEP's shorter and longer MDR-TB regimens (and the BPaLM regimen for fluoroquinolone-sensitive MDR-TB) rely on moxifloxacin and increasingly on clofazimine. Demonstrating susceptibility to both before starting these regimens prevents treatment failure and resistance amplification.
Amikacin is the preferred injectable when an injectable is still needed (with hearing monitoring) — capreomycin is also an option. Cycloserine remains a key oral companion drug in longer MDR-TB regimens despite its neurological side-effect profile.
How to prepare
Requires a positive M. tuberculosis culture. If not available, collect sputum (or other appropriate) sample for AFB MGIT culture first. Confirm the exact drug content of the panel with the lab — MACC is not a globally standardised abbreviation.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Moxifloxacin (Mfx) (—)[1] | Sensitive | — | Resistant — moxifloxacin not usable at standard dose. Higher-dose Mfx may be considered under specialist guidance if resistance is low level. Triggers pre-XDR or XDR pathway. |
| Amikacin (Am) (—)[1] | Sensitive | — | Resistant — amikacin cannot be used. Cross-resistance with kanamycin / capreomycin is frequent. |
| Capreomycin / Cycloserine (—) | Sensitive | — | Resistant — the drug should be replaced in the regimen. Confirm exactly which drug your lab reports under this slot. |
| Clofazimine (Cfz) (—)[1] | Sensitive | — | Resistant — clofazimine cannot be used. Cross-resistance with bedaquiline can occur (via Rv0678 mutations) — request bedaquiline DST when clofazimine resistance is found. |
When MACC results matter most
| Scenario | Why MACC matters |
|---|---|
| Pre-treatment MDR-TB workup | Confirms moxifloxacin & clofazimine susceptibility for all-oral regimen |
| BPaLM regimen consideration | Moxifloxacin sensitivity required |
| Treatment failure on MDR regimen | Identifies new resistance to companion drugs |
| Suspected bedaquiline resistance | Clofazimine resistance can indicate Rv0678 mutation — bedaquiline cross-resistance |
Frequently asked questions
Why is clofazimine in this panel?
Clofazimine is a key companion drug in modern all-oral MDR-TB regimens. Resistance is rising and can signal cross-resistance with bedaquiline, the most important new TB drug.
How long does the test take?
Approximately 1–2 weeks from a positive culture; about 4–6 weeks total from sputum sample collection.
Does the panel test bedaquiline?
Not directly. If clofazimine resistance is detected, bedaquiline DST should be requested separately because the resistance mechanisms (Rv0678 mutations) overlap.
Are amikacin and capreomycin still used?
Less commonly, since WHO and NTEP have moved to all-oral regimens. They are reserved for specific MDR-TB scenarios where other options are limited.
What does "Cycloserine" do?
Cycloserine is an oral companion drug in longer MDR-TB regimens. It has neurological side effects (mood change, peripheral neuropathy) that require monitoring.
Is the test available under NTEP?
NTEP labs perform second-line DST free of charge for enrolled MDR-TB patients. Private testing is also available through NABL-accredited mycobacteriology labs.
Why should I confirm the panel content with the lab?
MACC is an internal abbreviation that varies between labs. Some include Capreomycin, others Cycloserine. Confirming the exact drug list ensures the result will be useful for regimen design.
Related Tuberculosis / Mycobacterial tests
Tests commonly ordered alongside AFB DRUG SUSCEPTIBILITY (MACC) 2ND LINE, or that help interpret an unexpected result.
Sources & references
- WHO Consolidated Guidelines on Drug-Resistant TB · accessed 2026-05-30T00:00:00.000Z
- NTEP PMDT Guidelines · accessed 2026-05-30T00:00:00.000Z
- India TB Report 2024 · accessed 2026-05-30T00:00:00.000Z
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