Tuberculosis remains a major cause of morbidity and mortality globally, with an estimated nine million people developing the disease and 1.5 million deaths in 2013; equating to 4100 deaths a day.1 Nevertheless, considerable gains have been made in international tuberculosis control; incidence rates are decreasing (albeit slowly) and mortality has been reduced by 45% worldwide. The advent of multidrug resistant tuberculosis threatens this progress. In this review we detail the challenges faced globally in the diagnosis, treatment, and control of multidrug resistant tuberculosis and why this matters to high and low burden multidrug resistant tuberculosis settings alike...