The performance of flow cytometry and the microplate Alamar Blue assay in determining susceptibility of Mycobacterium tuberculosis was assessed by testing 150 Brazilian isolates. The overall agreement was 97.3 and 98% for isoniazid and 94.7 and 100% for rifampin by flow cytometry and MABA, respectively. This study was entirely done in a developing country.Many developing countries have serious difficulties obtaining drug susceptibility information for Mycobacterium tuberculosis isolates for financial or technical reasons. Treatment of tuberculosis without susceptibility information increases the risk of treatment failure and of the spread of resistant strains as well as the risk of the development of resistance to additional drugs (2,8).The commonly used agar proportion method for mycobacterial susceptibility testing requires a 3-to 4-week period of incubation before a pattern of susceptibility is established (3, 9). Flow cytometry that relies on fluoresceine diacetate (FDA) for detection has been used to perform susceptibility testing of M. tuberculosis and can yield results within 24 h. The inhibition by rifampin (RIF) and isoniazid (INH) of the ability of viable M. tuberculosis to hydrolyze FDA can be measured by flow cytometry. In addition, multiplication of the mycobacteria is not required (10,11,15).The microplate Alamar Blue assay (MABA) (7) has been reported to show very good correlations with the proportional and BACTEC methods. MABA is a resarzurin-based oxidation-reduction indicator which measures colorimetric drug MICs for M. tuberculosis for up to 7 days. In this study, we compared the flow cytometric and MABA tests with the standard proportional method to assess INH and RIF susceptibilities of 150 clinical isolates from a community in Rio de Janeiro, Brazil; 100 isolates were susceptible to both drugs, 50 were resistant to INH, and 37 of these 50 were also RIF resistant (multidrug resistant).The proportional method was performed according to the method of Canetti, Rist, and Grosset (3). The results obtained by the proportional method were used as a reference to compare the results of flow cytometry and MABA.For mycobacterium preparation, each isolate was grown in two Löwenstein-Jensen tubes (Difco, Detroit, Mich.) at 37°C in aerobic conditions for 30 days. After incubation, colonies were suspended in Middlebrook 7H9 medium (Difco) directly from solid medium and adjusted to a no. 1 McFarland standard (ϳ3 ϫ 10 7 CFU/ml).Flow cytometric susceptibility testing was performed according to the method of Norden et al. (11). The only modification was implemented to assure bacterial inactivation before analysis with an XL-MCL flow cytometer (Coulter, Miami, Fla.). In a previous study (data not published), we showed that M. tuberculosis cells can be killed by formaldehyde at a final concentration of 10% for 1 h.Final drug concentrations were 0.5, 1.0, and 2.0 g/ml for RIF and 0.1, 0.2, and 0.3 g/ml for INH. For each isolate the relative fluorescence value of each drug-containing sample was divided by the rela...