A high-resolution melting analysis (HRMA) assay was developed to detect isoniazid, rifampin, and ofloxacin resistance in Mycobacterium tuberculosis by targeting resistance-associated mutations in the katG, mabA-inhA promoter, rpoB, and gyrA genes. A set of 28 (17 drug-resistant and 11 fully susceptible) clinical M. tuberculosis isolates was selected for development and evaluation of HRMA. PCR amplicons from the katG, mabA-inhA promoter, rpoB, and gyrA genes of all 28 isolates were sequenced. HRMA results matched well with 18 mutations, identified by sequencing, in 17 drug-resistant isolates and the absence of mutations in 11 susceptible isolates. Among 87 additional isolates with known resistance phenotypes, HRMA identified katG and/or mabA-inhA promoter mutations in 66 of 69 (95.7%) isoniazid-resistant isolates, rpoB mutations in 51 of 54 (94.4%) rifampin-resistant isolates, and gyrA mutations in all of 41 (100%) ofloxacin-resistant isolates. All mutations within the HRMA primer target regions were detected as variant HRMA profiles. The corresponding specificities were 97.8%, 100%, and 98.6%, respectively. Most false-positive results were due to synonymous mutations, which did not affect susceptibility. HRMA is a rapid, sensitive method for detection of drug resistance in M. tuberculosis which could be used routinely for screening isolates in countries with a high prevalence of tuberculosis and drug resistance or in individual isolates when drug resistance is suspected.One-third of the world's population is reportedly infected with Mycobacterium tuberculosis, causing high mortality and morbidity. Eight million to nine million new tuberculosis (TB) cases and about 2 million deaths are reported each year (9, 18, 28). Multidrug-resistant TB (MDR-TB) is defined as resistance of the isolate to at least isoniazid (INH) and rifampin (RIF); extensively drug-resistant TB (XDR-TB) is MDR-TB in which the isolate has additional resistance to any of fluoroquinolones and at least one of three injectable second-line antituberculosis drugs used in TB treatment, namely, capreomycin, kanamycin, and amikacin (14, 21). MDR-TB and XDR-TB are major obstacles to the control of TB worldwide. More than 2.5 million patients were diagnosed with active TB in 116 countries and regions in 2006; of them, 4.8% had MDR-TB (3). About one in six (15%) patients with MDR-TB had previously received treatment for TB for at least 1 month (18), and at least 8.0% had XDR-TB, according to incomplete data collected from 37 countries between 2002 and 2007 (41).Drug susceptibility testing using molecular techniques can enhance the identification of drug-resistant M. tuberculosis. Several scanning methods are available for detection of drug resistance mutations, including denaturing gradient gel electrophoresis, conformation-sensitive gel electrophoresis, temperature gradient capillary electrophoresis, denaturing high-performance liquid chromatography (dHPLC), and high-density oligonucleotide arrays (15,20,22,30,31,33). These methods vary in sensitivity and...