The global emergence of resistance to the anti-tuberculosis (TB) drugs has posed a serious challenge to the efforts of program managers and the health workers all across the world to reduce the magnitude of TB. From a public health perspective, early diagnosis of drug-resistant TB cases and initiation of the patient on second-line anti-TB drugs is the key strategy as MDR-TB is associated with poor cure rate, poor treatment success rate, high default rate, fatal and non-fatal complications, transmission to contacts and deaths. The primary step to ensure a good outcome is to initiate the treatment regimen based on the results of a pre-treatment evaluation (PTE) performed at the drug resistant TB center by an expert committee. Altogether, PTE plays a critical role in ensuring a successful outcome to the treatment of drug-resistant TB as a comprehensive PTE can build a key foundation by averting the probable drug induced side effects right at the start of the treatment.