This test evaluates the susceptibility of mycobacterial isolates (typically the Mycobacterium tuberculosis complex) to both first-line and second-line anti-tuberculosis drugs. It is used when drug resistance is suspected—such as in treatment failure or when patients have been exposed to resistant strains. The first-line drugs include isoniazid, rifampicin, ethambutol and pyrazinamide; the second-line drugs often include fluoroquinolones (moxifloxacin, levofloxacin), aminoglycosides (amikacin, kanamycin), capreomycin, ethionamide, and other agents.