For the first-line antituberculosis drugs, there is a clear correlation between the drug susceptibility testing (DST) results assayed in vitro and the clinical usefulness of the drug (25). Moreover, for many years there has been a generally accepted consensus on how laboratory testing of the drug susceptibility of Mycobacterium tuberculosis should be performed (5,6,14,24,27). For most second-line drugs and new alternative compounds for treatment of drug-resistant tuberculosis (TB), there is a lack of accepted standard techniques for drug testing as well as full understanding of the clinical interpretation of test results.Much recent attention has focused on assessing the global burden of multidrug-resistant (MDR) TB and predicting the future threat of the pathogen. At present, MDR TB continues to be a serious problem, particularly in developing countries in Asia (11, 12), but also in the Baltic region (9, 22) and in other parts of the former Soviet Union (3,10,26,29,33).The increase in MDR TB rates has led to pressing demands for appropriate treatment with second-line antituberculosis drugs, and accurate and reliable drug susceptibility testing, not only for individual case management, but also for drug resistance surveillance (13). Consequently, laboratories are challenged to provide reliable (and ideally rapid) drug susceptibility testing for first-and second-line drugs to ensure effective treatment of tuberculosis worldwide.The reliability of the Becton Dickinson MGIT 960 system for rapid testing of Mycobacterium tuberculosis susceptibility to front-line drugs has been evaluated in several single-and multicenter studies (1,2,4,5,19,21,31,32). However, in most of these studies, only critical concentrations of drugs were tested (1,19,32) and/or limited numbers of drug-resistant and MDR M. tuberculosis strains were included in the analysis (2,4,18,19,21,32). Drug-resistant isolates are likely to exhibit physiological variations in parameters such as growth compared to drug-sensitive strains.In seven out of the eight studies described above, the MGIT 960 system was evaluated against the BACTEC 460TB system, confirming good reproducibility between liquid-medium-based systems made by the same company. There is no published analysis available for the MGIT 960 system for second-line DST including significant numbers of drug-resistant isolates.In light of this, the primary aim of our study was to test a large number of M. tuberculosis isolates (132 MDR, 40 drugresistant, and 28 drug-sensitive M. tuberculosis isolates) against the critical and high concentrations of first-line drugs using a solid-medium-based resistance ratio method (RRM) as a reference method for comparison with the MGIT 960 system.