According to a commentary, an implication of these findings is that the prescription of pyrazinamide should be carefully evaluated in rifampicin-resistant cases. It notes that rifampicin resistance can now be identified within just a few hours, and, if present, should lead to testing for resistance to pyrazinamide and fluoroquinolones. It adds that although the overall prevalence of fluoroquinolone resistance was low, the increased prevalence in some settings (e.g. Pakistan and Bangladesh) raises concerns and questions the wisdom of empirical prescription of fluoroquinolones to patients with lower respiratory tract infections. It highlights that the new WHO-recommended regimen for multi-drug resistant tuberculosis, which is expected to increase patients’ adherence and programmatic sustainability (being shorter and cheaper), includes pyrazinamide and fluoroquinolones among its core drugs. Due to the variability in drug resistance patterns, it calls for understanding of national and subnational epidemiology, and stresses the need for rapid molecular methods and drug susceptibility testing to exclude drug resistance whenever there is suspicion that it might be present. The commentary concludes that only with accurate and timely diagnosis will the spread of drug-resistant tuberculosis be contained.