Tuberculosis remains a worldwide public health problem. India has the highest burden of tuberculosis in the world and accounts for nearly 2/5th of global burden and 2/3rd of burden in SEAR countries. The XDR- TB was first described in March 2006 and has also been reported in India. The emergence of XDR – TB is associated with a very low probability cure and a high case fatality as evidenced by various researchers. Extensively drug-resistant tuberculosis is rapidly fatal if not treated. Some studies reveal a new and brighter perspective: even in developing countries, extensively drug-resistant tuberculosis may be cured in the majority of cases when management is aggressive and appropriate. What is required is action that is borne out of clear planning, financial commitment and adequate resources, technical capacity, and partnership. Increase in cure rates could be achieved by perfecting the supervision, support and monitoring concerning management of XDR-TB.