Emerging cases of multi drug resistant tuberculosis and extensively drug resistant TB cases pose serious threat to TB control efforts. The systematic review of  burden of drug resistant tuberculosis, challenges regarding diagnosis and treatment is presented in this article. In India  prevalence of acquired drug resistance is comparatively more than  primary drug resistance. The diagnosis of XDR-TB has enormous implications both for the individual and the community. The choice of anti-TB drugs is limited and the ones available are too expensive and too reactogenic.Treatment outcome is mostly disappointing and case-fatality rate  is very high in drug resistant truberculosis.Therefore prompt adherence to DOTS regime, ensuring nationwide access to dignostic and treatment facilities under RNTCP, integrated TB control activities by private and public sector, political commitment ,promoting research and development of national guidelines and policies  will definitely help to combat manmade disaster of drug resistant tuberculosis.