Aminoglycoside antibiotics such as amikacin and kanamycin are important components in the treatment of (Mtb) infection. However, more and more clinical strains are found to be aminoglycoside antibiotic-resistant. Apramycin is another kind of aminoglycoside antibiotic that is commonly used to treat infections in animals. Apramycin may have activity against Mtb. This study aims to evaluate the efficacy of apramycin against Mtb and determine its epidemiological cut-off (ECOFF) value. One hundred Mtb isolates, including 17 pansusceptible and 83 drug-resistant tuberculosis (DR-TB) strains, were analysed for apramycin resistance using the MIC assay. Apramycin exhibited significant inhibitory activity against Mtb clinical isolates, with an MIC of 0.5 μg ml and an MIC of 1 μg ml. We determined the tentative ECOFF value as 1 µg ml for apramycin. The resistant rates of multidrug-resistant tuberculosis (MDR-TB), pre-extensively drug-resistant (pre-XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) strains were 12.12 % (4/33), 20.69 % (6/29) and 66.67 % (14/21), respectively. The gene A1401G is associated with apramycin resistance, as well as the cross-resistance between apramycin and other aminoglycosides. Apramycin shows high activity against the Mtb clinical isolates, especially the MDR-TB clinical isolates. This encouraging discovery calls for more research on the functions of apramycin and as a possible antibiotic for the treatment of drug-resistant TB.
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