What this test measures
This test determines whether a cultured M. tuberculosis isolate is sensitive or resistant to capreomycin at the WHO-defined critical concentration. Capreomycin is a cyclic peptide injectable antibiotic that inhibits bacterial protein synthesis at a different site from the aminoglycosides but with overlapping resistance mechanisms (tlyA, rrs mutations).
Why it matters
Capreomycin used to be a backbone of MDR-TB injectable regimens but has been deprioritised by WHO and NTEP in favour of all-oral regimens. It remains useful in salvage situations or where amikacin / kanamycin are contraindicated or resistant. Cross-resistance with amikacin and kanamycin is common, so capreomycin DST often mirrors the rest of the injectable panel.
Like all aminoglycoside-like drugs, capreomycin has ototoxic and nephrotoxic side effects, so its use is monitored with audiometry and creatinine.
How to prepare
A positive M. tuberculosis culture (MGIT or LJ) is required. If not 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.
Injectables: cross-resistance patterns
| Drug | Resistance gene(s) | Cross-resistance |
|---|---|---|
| Streptomycin | rpsL, rrs | Limited |
| Kanamycin | rrs (a1401g) | Amikacin, Capreomycin |
| Amikacin | rrs | Kanamycin, Capreomycin |
| Capreomycin | rrs, tlyA | Kanamycin, Amikacin |
Frequently asked questions
Is capreomycin used in modern MDR-TB regimens?
Rarely — WHO and NTEP now prefer all-oral regimens. Capreomycin is reserved for salvage cases when other options are not available.
What side effects should I watch for?
Hearing loss, balance issues, kidney injury, and electrolyte disturbance (low potassium, magnesium, calcium). Audiometry and creatinine are monitored throughout treatment.
If I am amikacin-resistant, will I also be capreomycin-resistant?
Usually yes — the rrs gene mutations confer cross-resistance. Confirm with the actual DST report.
How long does the test take?
About 7–14 days from a positive culture; 4–6 weeks total from sputum collection.
Is the test available under NTEP?
Yes, at NTEP intermediate and national reference labs for eligible MDR-TB patients. Private testing is also available.
Why is capreomycin in the panel if it is rarely used?
Drug-resistance surveillance and salvage-regimen design still benefit from knowing the capreomycin status, particularly in XDR-TB.
What if I am pregnant and need capreomycin?
Capreomycin is generally avoided in pregnancy. Your specialist will balance the risks of TB against drug toxicity and choose alternative agents wherever possible.
Related Tuberculosis / Mycobacterial tests
Tests commonly ordered alongside ANTIBIOGRAM - MTB (CAPREOMYCIN), 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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