Mycobacterial growth was monitored by bioluminescence assay of mycobacterial ATP. Cultures of Mycobacterium tuberculosis H37Rv and of 25 clinical isolates of the same species were exposed to serial dilutions of ethambutol, isoniazid, rifampin, and streptomycin. A suppression of ATP, indicating growth inhibition, occurred for susceptible but not resistant strains within 5 to 7 days of incubation. Breakpoint concentrations between susceptibility and resistance were determined by comparing these results with those obtained by reference techniques. Full agreement was found in 99% of the assays with the resistance ratio method on Lowenstein-Jensen medium, and 98% of the assays were in full agreement with the radiometric system (BACTEC). A main advantage of the bioluminescence method is its rapidity, with results available as fast as with the radiometric system but at a lower cost and without the need for radioactive culture medium. The method provides kinetic data concerning drug effects within available in vivo drug concentrations and has great potential for both rapid routine susceptibility testing and research applications in studies of drug effects on mycobacteria.Testing of Mycobacterium tuberculosis susceptibility to antimycobacterial agents on the basis of growth on solid media requires 3 to 4 weeks of incubation (2, 3). Among these methods, the resistance ratio method on LowensteinJensen medium (2) is most used in Europe, while the plate proportional method on 7H10 agar (3) is the main method used in the United States. To achieve more rapid susceptibility testing, alternative techniques based on bacterial growth in broth cultures have been adapted. The rapid radiometric system (BACTEC) quantifies 14CO2 produced by mycobacteria growing in broth containing 14C-labeled palmitic acid (4). Results are provided after 1 week of incubation, and susceptibility is defined as a 99% reduction of the metabolic activity of a drug-exposed culture compared with that of an unexposed control culture (9). This technique is widely used, and the results are in good agreement with those of reference methods on solid media (4,(8)(9)(10)(11).The firefly bioluminescence assay of bacterial ATP has been used for studies of effects of antimicrobial agents on various bacteria (6, 7) and for rapid susceptibility testing of M. tuberculosis (1).The aim of this study was to evaluate this technique for rapid susceptibility testing of M. tuberculosis by comparing it with the resistance ratio method on Lowenstein-Jensen medium and with the rapid radiometric system (BACTEC). Antimycobacterial agents. Stock solutions of 10,000 pLg of active drug per ml were prepared from ethambutol (Cyanamid of Great Britain Ltd., Gosport, England), isoniazid (Ferrosan, Malmo, Sweden), rifampin (Ferrosan), and streptomycin (Glaxo Laboratories Ltd., Greenford, England). standard. The same inoculum was added to one drug-free vial (control A), and for determining the 1% proportion of resistance, another drug-free vial (control B) was inoculated with a 100-fold dilut...