jThe aim of this study was to establish standardized drug susceptibility testing (DST) methodologies and reference MIC quality control (QC) ranges for bedaquiline, a diarylquinoline antimycobacterial, used in the treatment of adults with multidrug-resistant tuberculosis. Two tier-2 QC reproducibility studies of bedaquiline DST were conducted in eight laboratories using Clinical Laboratory and Standards Institute (CLSI) guidelines. Agar dilution and broth microdilution methods were evaluated. Mycobacterium tuberculosis H37Rv was used as the QC reference strain. Bedaquiline MIC frequency, mode, and geometric mean were calculated. When resulting data occurred outside predefined CLSI criteria, the entire laboratory data set was excluded. N ewer drugs are being developed to counter the growing problem of multidrug-resistant (MDR) strains of Mycobacterium tuberculosis. Of the 9.6 million estimated new M. tuberculosis cases occurring globally in 2014, 3.3% were MDR, in addition to 20% of previously treated tuberculosis (TB) cases estimated to have MDR; this equates to an overall estimate of 480,000 people with MDR-TB annually. Furthermore, current treatment outcome data for patients started on MDR-TB treatment in 2015 suggest a success rate of only 50% (1). The approval of new antimycobacterials effective against MDR-TB strains has highlighted the need for validated and standardized drug susceptibility testing (DST) methods to enhance patient care and for facilitating drug resistance surveillance.Bedaquiline, a diarylquinoline antimycobacterial (2), has received accelerated/conditional approval for use based on phase II trials in the United States (2012), the European Union (2014), and 7 countries with high MDR-TB burden (3-8). Interim policy guidance for the use of bedaquiline as part of combination therapy for adults who have pulmonary MDR-TB has been issued by the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) (9, 10).Preliminary DST methodology for bedaquiline was previously piloted and then used in two phase II clinical studies (3-6). In these studies, bedaquiline DST was performed by 7H11 agar dilution and 7H9 broth microdilution methods using the resazurin microtiter assay (REMA) (11,12). For bedaquiline DST, the standard quality control (QC) strain M. tuberculosis H37Rv should be used under the same conditions as the clinical M. tuberculosis isolates to ensure that the bedaquiline MIC of the reference falls within a predefined QC range. For QC purposes when testing clinical isolates prior to the present study, the provisional bedaquiline MIC ranges against strain H37Rv were 0.03 to 0.12 g/ml for 7H11 agar and 0.03 to 0.12 g/ml for REMA (7H9