Drug resistance is threatening attempts at tuberculosis epidemic control. Molecular diagnostics for drug resistance that rely on the detection of resistance-related mutations could expedite patient care and accelerate progress in TB eradication. We performed minimum inhibitory concentration testing for 12 anti-TB drugs together with Illumina whole genome sequencing on 1452 clinical Mycobacterium tuberculosis (MTB) isolates. We then used a linear mixed model to evaluate genome wide associations between mutations in MTB genes or noncoding regions and drug resistance, followed by validation of our findings in an independent dataset of 792 patient isolates. Novel associations at 13 genomic loci were confirmed in the validation set, with 2 involving noncoding regions. We found promoter mutations to have smaller average effects on resistance levels than gene body mutations in genes where both can contribute to resistance. Enabled by a quantitative measure of resistance, we estimated the heritability of the resistance phenotype to 11 anti-TB drugs and identify a lower than expected contribution from known resistance genes. We also report the proportion of variation in resistance levels explained by the novel loci identified here. This study highlights the complexity of the genomic mechanisms associated with the MTB resistance phenotype, including the relatively large number of potentially causative or compensatory loci, and emphasizes the contribution of the noncoding portion of the genome.2 Introduction: Tuberculosis (TB) remains a major global public health threat. In 2016 there were an estimated 10.4 million TB cases globally and 1.7 million deaths due to the disease. One of the most challenging forms of disease is caused by multidrug resistant (MDR) Mycobacterium tuberculosis, with a global annual incidence of over half a million cases 1 . The World Health Organization (WHO) estimates that only two of every three patients with multidrug resistant TB are diagnosed, three in every four of the diagnosed are treated, and only one of every two of the treated patients are cured, resulting in the grim reality of about 75% of the incident cases persisting in the community or succumbing to their illness. Antibiotic resistance is also an increasing problem in other human pathogens, and transmission of antibiotic resistance from person to person is amplifying the public health threat 2 .Improved surveillance, diagnosis and treatment are designated priorities by the WHO and the US, European CDCs for addressing the antibiotic resistance challenge 1,3,4 . These measures will rely on an improved understanding of the mechanisms of resistance acquisition in bacteria. The knowledge of genetic mechanisms of antibiotic resistance has formed the basis of several commercial molecular diagnostics for TB that have had remarkable global uptake, despite the fact that they only reliably test for a subset of TB drugs and hence have not yet been able to replace the traditional more costly and slow process of mycobacterial culture and drug susce...