Used as a second-line antibiotic in the treatment of multidrug-resistant tuberculosis (MDR-TB), particularly when first-line drugs are ineffective or not tolerated. It is administered by injection and works by inhibiting bacterial protein synthesis, targeting the mycobacterial ribosome. Due to its potential for kidney and hearing toxicity, it is typically reserved for serious cases under close medical supervision. Often used in combination with other anti-TB agents to improve efficacy and reduce the risk of further resistance development.