Introduction: An estimated 9.9 million people fell ill with tuberculosis globally in 2020 with India and China contributing a major percentage to the burden of TB. India is grouped under high TB, high HIV associated TB and MDR TB burden countries and 1.24 lakh fell ill with drug resistant TB out of which 56000 were started on second line treatment in 2020. Annually India accounts for 27% of missing TB cases. Diagnosis: The major forms of drug resistant TB that are of clinical importance are INH monoresistant TB, multidrug resistant TB, pre- XDR TB and XDR TB.WHO approved newer molecular tests for MTB detection and drug susceptibility tests. Treatment: Few newer drugs and few previously used drugs are showing promise when used in combination which have come up in recent years. Bedaquiline based regimens are showing improved cure rates. Conclusion: Guidelines based regimens should be strictly adhered to by both public and private TB case treating physicians.