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In order to improve the adherence and treatment outcomes of multidrug-resistant (MDR) tuberculosis (TB) patients, the World Health Organization (WHO) has recently recommended a new, shorter and cheaper treatment regimen. The new regimen, comprised of 4-6 months of kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, ethambutol and high dose isoniazid followed by 5 months of moxifloxacin, clofazimine, pyrazinamide and ethambutol [1], has produced excellent outcomes under operational research conditions is various settings [2][3][4]. However, the recommendation that it should be used only for MDR-TB patients who are neither previously treated with second-line anti-TB drugs, nor resistant to fluoroquinolones or injectable second-line anti-TB drugs [1], generates concerns about its applicability in MDR-TB high burden countries [5]. In the current cross-sectional study, culture-confirmed MDR-TB patients treated at two units for programmatic management of drug-resistant TB in Pakistan were evaluated for drug resistance pattern and eligibility to be treated with the new shorter regimen.A total of 832 culture-confirmed MDR-TB patients consecutively enrolled for treatment at Lady Reading Hospital Peshawar (Khyber-Pukhtoonkhwa) and Nishtar Hospital Multan (Punjab) from January 2012 to July 2016 met the inclusion criteria and were included in the study. Patients with drug-resistant TB other than MDR-TB (extensively drug-resistant, poly-drug-resistant and mono-drug-resistant TB) and who had a history of MDR-TB treatment were excluded. At the study sites, presumed drug-resistant TB patients were initially evaluated with two sputum samples for acid-fast bacilli by direct sputum smear microscopy using Ziehl Neelsen staining method and GeneXpert System's MTB/Rif (Mycobacterium tuberculosis/rifampicin). Upon positive smear microscopy and rapid drug susceptibility test (DST), sputum samples were sent to

Prevalence of drug resistance in retreatment isolates was high. The alarmingly high prevalence of OFX resistance among MDR-TB isolates may threaten the success of efforts to control and treat MDR-TB.

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