Resistance to antituberculosis drugs has been documented since the 1940s, when the first medicines for tuberculosis were introduced. Since the initiation in 1994 of a global project to monitor the development of drug-resistant tuberculosis, nearly 60% of all countries in the world have implemented surveillance activities. In the past 15 years, special surveys have been the most common approach to investigate the frequency and patterns of drug-resistant tuberculosis. The major obstacle to the expansion of routine surveillance activities has been the lack of laboratory capacity needed to detect resistance. We are now in a new era for antituberculosis drug resistance surveillance due to the advent of new diagnostic tools and global commitment towards universal access to care for all patients with tuberculosis, including those with drug-resistant disease. Routine surveillance linked to patient care, which represents the best approach to monitor drug resistance, now has the possibility of becoming a reality even in resource-limited countries.