10.22376/ijpbs.2019.10.1.p1-12 Volume 3 Issue 2 2012 (April - June) Extensively drug resistant tuberculosis ( XDR- TB) has been reported by 45 countries worldwide , to World Health Organisation ( WHO ) . XDR-TB is a uniformly lethal disease that has emerged in countries with limited resources and high prevalence of tuberculosis , mainly as a result of previous inadequate or improper treatment and poor adherence by the patient to the treatment . It has been defined by WHO Global Task Force as – lessThan i greaterThan Mycobacterial tuberculosis lessThan /i greaterThan  infection that is resistant to isoniazid , rifampicin , any fluoroquinolone and at least one of the three injectable drugs i.e. amikacin , kanamycin and capreomycin . Patients co-infected with HIV were found to be at more risk to XDR- TB. An aggressive drug treatment regimens, as a part of comprehensive therapeutic approach including infection control measures, along with DOTS – plus implemented by WHO are required that can cure many patients with XDR – TB , who are not infected with HIV. Along with rapid recognition of cases and prompt contact recognition , drug therapy includes as first line agents , ethambutol and pyrazinamide for the entire duration of therapy . An injectable agent like kanamycin in streptomycin resistant cases , amikacin in kanamycin and streptomycin resistant cases , capreomycin and vyomycin in cases of kanamycin or streptomycin resistant cases should be included , along with monitoring for ototoxicity and nephrotoxicity . Dr. Sangeeta Bhanwra XDR-TB , DOTS-PLUS, injectable agents 124-127