What this test measures
This test determines whether a cultured M. tuberculosis isolate is sensitive or resistant to amikacin at the WHO-defined critical concentration. Amikacin is an injectable aminoglycoside that inhibits bacterial protein synthesis. In TB, it is one of the second-line drugs used historically in MDR-TB regimens; resistance to amikacin frequently co-occurs with resistance to kanamycin and capreomycin (shared 16S rRNA mutations).
Why it matters
WHO and India's NTEP have moved largely to all-oral MDR-TB regimens, reducing reliance on injectables — but amikacin remains useful in selected MDR / pre-XDR / XDR cases when other options are limited or contraindicated. Knowing the susceptibility status helps the specialist decide whether amikacin can be safely added to a regimen.
Amikacin has well-known toxicities (ototoxicity and nephrotoxicity), so it is used only when essential and with audiometry and creatinine monitoring. Resistance also has surveillance implications under India's drug resistance survey.
How to prepare
Requires a positive M. tuberculosis culture (MGIT or LJ). If not yet available, sputum samples must be collected for AFB culture first.
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.
Injectable aminoglycosides in TB
| Drug | Class | Role today |
|---|---|---|
| Streptomycin | Older aminoglycoside | Rarely used |
| Kanamycin | Aminoglycoside | Largely phased out |
| Amikacin (this test) | Aminoglycoside | Preferred injectable when one is needed |
| Capreomycin | Cyclic peptide | Alternative injectable; cross-resistance with Km/Am |
Frequently asked questions
Is amikacin still used in MDR-TB?
Less commonly than before. WHO and NTEP have shifted to all-oral regimens with bedaquiline, linezolid and pretomanid. Amikacin is reserved for cases where these are not available or contraindicated.
What are the main side effects of amikacin?
Hearing loss (sometimes permanent) and kidney injury. Patients on amikacin need regular audiometry and creatinine monitoring.
If I am resistant to amikacin, am I resistant to kanamycin too?
Usually yes — they share resistance mechanisms (16S rRNA gene mutations). Capreomycin cross-resistance is also common.
How long does the test take?
About 7–14 days from a positive culture. Total time from sputum collection is typically 4–6 weeks.
Should I take amikacin DST if I am on an all-oral regimen?
Usually not necessary unless treatment is failing and the specialist is considering injectable salvage options.
Is this test available under NTEP?
Yes — second-line DST is offered at NTEP intermediate and national reference labs for eligible patients. Private NABL-accredited labs also offer it.
Where is amikacin used outside TB?
Amikacin is a broad-spectrum aminoglycoside used for serious gram-negative infections, certain mycobacterial infections (including some NTM), and complicated UTIs.
Related Tuberculosis / Mycobacterial tests
Tests commonly ordered alongside ANTIBIOGRAM - MTB (AMIKACIN), 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
- CDC — TB Laboratory Diagnostics · accessed 2026-05-30T00:00:00.000Z
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