Infection with Mycobacterium tuberculosis remains a major global health problem and the recent outbreaks of multidrug resistant (MDR) tuberculosis have been a major cause for concern. An accurate picture of the extent of this problem is not possible because only a limited number of countries have reliable surveillance programmes. However, the experience in the USA reinforces the need for strict adherence to standard public health measures and good clinical practices to minimise the impact of MDR tuberculosis in the human immunodeficiency virus era.