Additionally, Aph(3′)-IIa was shown in vitro to be capable of extending its antibiotic inactivation spectrum to amikacin—an essential agent for the treatment of severe systemic infections caused by Gram negative bacteria and a crucial second-line antibiotic for combatting multidrug-resistant tuberculosis (Durante-Mangoni et al., 2009; WHO, 2011)–due to an exchange of a single amino acid (Kocabiyik and Perlin, 1992). This evidence concerns the gene APEH and tuberculosis.