A new strategy known as multiplex PCR amplimer conformation was developed for detection of mutation in the gyrA gene of 138 clinical isolates of Mycobacterium tuberculosis. The method generated a single-stranded and heteroduplex DNA banding pattern of multiplex PCR amplimers of the region of interest that was extremely sensitive to specific mutations, thus enabling much more sensitive and reliable mutation analysis compared to the standard single-stranded conformation polymorphism technique. The genetic profiles of the gyrA gene of the 138 isolates as detected by MPAC were confirmed by nucleotide sequencing and were found to correlate strongly with the in vitro susceptibilities of the mutant strains to six fluoroquinolones (ofloxacin, levofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, and sitafloxacin). All 32 isolates that contained gyrA mutations exhibited cross-resistance to the six fluoroquinolones (ofloxacin MIC for 90% of strains > 16 mg/liter), although moxifloxacin, gatifloxacin, and sitafloxacin (MIC for 90% of strains < 4 mg/liter) were apparently more active than ofloxacin, levofloxacin, and sparfloxacin (MIC for 90% of strains > 16 mg/liter). All gyrA mutations were clustered in codons 90, 91, and 94, and aspartic acid 94 was most frequently mutated. Twenty-three isolates without gyrA mutations were also found to exhibit reduced susceptibility to ofloxacin (MIC for 90% of strains ؍ 4 mg/liter), but largely remained susceptible to other drugs (MIC for 90% of strains < 1 mg/liter). Another 83 isolates without mutations were fully susceptible to all six fluoroquinolones (ofloxacin MIC for 90% of strains ؍ 1 mg/liter). In conclusion, high-level phenotypic resistance to fluoroquinolones among M. tuberculosis clinical isolates, which appears to be predominantly due to gyrA mutations, may be readily detected by genotyping techniques such as multiplex PCR amplimer conformation.Fluoroquinolones have antimycobacterial activities that possibly contribute a pivotal role in the second-line drug regimens used in the treatment of multidrug-resistant tuberculosis (32). However, in some communities, the resistance rates of Mycobacterium tuberculosis to these agents are surging (6, 9). To date, the genetic basis of this phenomenon has been attributed predominantly to mutations in the quinolone resistance-determining region of the gyrA gene (1,10,28,31).It would be of great relevance not only to study the genetic mutations responsible for fluoroquinolone resistance, but also to establish, as far as possible, their correlation with the resistance phenotypes of clinical isolates of M. tuberculosis. Such information facilitates rapid determination of the fluoroquinolone susceptibility status of the isolates and helps improve the clinical utility of these drugs in the settings of multidrug-resistant tuberculosis, as in cases involving streptomycin-and rifampin-resistant strains of M. tuberculosis (19,21). Hence, the major objective of this study was to identify the gyrA mutation(s), if any, in 138 clinical isolate...