Members of the Mycobacterium tuberculosis complex possess a resistance determinant, erm(37) (also termed ermMT), which is a truncated homologue of the erm genes found in a diverse range of drug-producing and pathogenic bacteria. All erm genes examined thus far encode N 6 -monomethyltransferases or N 6 ,N 6 -dimethyltransferases that show absolute specificity for nucleotide A2058 in 23 S rRNA. Monomethylation at A2058 confers resistance to a subset of the macrolide, lincosamide, and streptogramin B (MLS B ) group of antibiotics and no resistance to the latest macrolide derivatives, the ketolides. Dimethylation at A2058 confers high resistance to all MLS B and ketolide drugs. The erm(37) phenotype fits into neither category. We show here by tandem mass spectrometry that Erm(37) initially adds a single methyl group to its primary target at A2058 but then proceeds to attach additional methyl groups to the neighboring nucleotides A2057 and A2059. Other methyltransferases, Erm(E) and Erm(O), maintain their specificity for A2058 on mycobacterial rRNA. Erm(E) and Erm(O) have a fulllength C-terminal domain, which appears to be important for stabilizing the methyltransferases at their rRNA target, and this domain is truncated in Erm(37). The lax interaction of the M. tuberculosis Erm(37) with its rRNA produces a unique methylation pattern and confers resistance to the ketolide telithromycin.Tuberculosis is caused by infection with bacteria belonging to the Mycobacterium tuberculosis complex (MTC) 4 and is responsible for 2 million deaths per annum worldwide with almost one-third of the world's population harboring asymptomatic infections (1). Treatment for tuberculosis often requires extended courses with several antibiotics, and with resistant strains becoming more prevalent (2), drug therapy is not always successful. In the absence of new antimycobacterial drugs, a better understanding of the resistance mechanisms to existing drugs is desirable.Members of the MTC include Mycobacterium africanum, Mycobacterium microti, Mycobacterium bovis, and M. tuberculosis, all of which are intrinsically resistant to macrolide antibiotics (3-5). Although this is due in part to the imperviousness of the mycobacterial cell wall (6), the recently discovered resistance determinant, erm(37) (formerly ermMT), also contributes to the lack of macrolide susceptibility in MTC species (7). The erm(37) determinant is a truncated homologue of the erm genes found in a diverse range of pathogenic and drug-producing bacteria (8). Members of the erm family of genes all encode methyltransferases that specifically methylate the N 6 position of nucleotide A2058 in 23 S rRNA (Escherichia coli numbering) but differ as to whether they monomethylate or dimethylate this nucleotide (9, 10). Erm monomethyltransferases are found predominantly in drug-producing actinomycetes species and confer the MLS B type I phenotype with high resistance to lincosamides, low to moderate resistance to macrolide and streptogramin B antibiotics (10, 11), but no resistance to the ...