We describe a novel, simple, rapid, and highly sensitive method to detect single-nucleotide polymorphisms (SNPs) in Mycobacterium tuberculosis and other organisms. Amplification refractory mutation (ARMS) SNP assays were modified by converting the SNP-detecting linear primers in the ARMS assay to hairpin-shaped primers (HPs) through the addition of a 5 tail complementary to the 3 end of the linear primer. The improved ability of these primers to detect SNPs in M. tuberculosis was compared in a real-time PCR with SYBR-I green dye. Linear primers resulted in incorrect or indeterminate allele designation for 6 of the 13 SNP alleles tested in seven different SNP assays, while HPs determined the correct SNP in all cases. We compared the cycle threshold differences (⌬C t ) between the reactions containing primer-template matches and the reactions containing primer-template mismatches (where a larger ⌬C t indicates a more robust assay). The use of HPs dramatically improved the mean ⌬C t values for the SNP assays (7.6 for linear primers and 11.2 for HPs). We designed 98 different HP assays for SNPs previously associated with resistance to the antibiotic isoniazid to test the large-scale utility of the HP approach. Assay design was successful in 72.4%, 83.7%, 88.8%, and 92.9% of the assays after one to four rounds of assay design, respectively. HP SNP assays are simple, sensitive, robust, and inexpensive. These advantages favor the application of this technique for SNP assays of M. tuberculosis and other organisms.Single-nucleotide polymorphism (SNP) analysis is becoming increasingly important for studies of drug resistance, evolution, and molecular epidemiology in Mycobacterium tuberculosis (2,7,9,18,(20)(21)(22), human immunodeficiency virus (3, 10, 15), and other organisms (12,23,26,31,32). High-throughput SNP analysis can be particularly beneficial for confirming associations between specific SNPs and a phenotype of interest, such as drug resistance. The ideal SNP detection method should be simple to design, easy to perform under uniform assay conditions (so that multiple SNP assays can be performed simultaneously), easy to automate, and inexpensive. Most approaches, including DNA sequencing and its derivations (9, 22), microarrays (6), allele-specific amplification (33), mass spectrometrybased techniques (27), TaqMan probes (14), and molecular beacons (28), represent a tradeoff between cost, throughput, and flexibility.We developed an improved SNP detection method to enable us to analyze large numbers of M. tuberculosis isolates. Most causes of drug resistance in M. tuberculosis appear to be the result of SNPs in particular target genes. However, each SNP occurs at a relatively low frequency. Therefore, in the absence of large sequencing studies, it has been difficult to establish statistically valid associations between individual SNPs and resistance to a particular drug. In the case of resistance to the antibiotic isoniazid, only mutations in codon 315 of the katG gene occur with sufficient frequency. The danger o...