Globally, there is substantial concern regarding the challenges of treating complex drug
resistance patterns in multidrug resistant tuberculosis cases. Utilising data from three different
settings (Estonia, Latvia, Romania) we sought to contrast drug susceptibility profiles for
multidrug resistant tuberculosis cases, highlight the difficulties in designing universal regimen,
and inform future regimen selection. Demographic and microbiological surveillance
data for multidrug resistant tuberculosis cases from 2004–13 were analysed. High levels of
additional resistance to currently recommended second line drugs were seen in all settings,
with extensive variability between countries. Accurate drug susceptibility testing and drug
susceptibility testing data are vital to inform the development of comprehensive, flexible,
multidrug resistant tuberculosis guidance.