The unsurprising story of MDR-TB resistance in India.

W.H.O. defines Totally Drug-Resistant Tuberculosis (TDR-TB) as Tuberculosis caused due to a virulent strain of tuberculosis that seems to be resistant to all known treatments. In a recent correspondence, Zarir F. Udwadia and others described what they termed as "first patients from India with TDR tuberculosis". The processes and weakness ingrained in the vastness of Indian society and health system leading to drug resistance reveal multitude layers of weakness. This review aims at listing some of the important factors and levels responsible for the development of resistance in TB. The review identifies access issues, poor adherence to short-course chemotherapy, poor knowledge, practices and quality TB drugs in the private sector, resistance against some of second-line drugs prevalent in India and poor utilization of diagnostic services as the factors for causing TB resistance in India.