**Abstract**

History hallmarks different out brakes events during the last century. Being caught in the in the middle of the catastrophic COVID-19 pandemic, that initiated in 2019 makes possible to forget other causalities. Tuberculosis makes the case. The pathogen has been present more than hundredth years. Relevance rest in worldwide prevalence, pathogen spread, treatment resistance and the need for eradication. Drug treatment resistance is considered as one of the criteria to prioritize a country in the World Health Organization's intention to eradicate tuberculosis infection in the world. For decades in Latin America, including the Caribbean, there have been a persistent high rate of drug resistance with an overall prevalence to one or more drug rounds 13.0%. Approximately 30% of previously treated cases have a multidrug resistance. In this chapter, we intend to review the epidemiology of resistant tuberculosis, and the causes of resistance associated to the community of people in the Latin American and the Caribbean. We intend to describe the genetic response of *Mycobacterium tuberculosis* from its migratory journey throughout decades from areas of Europa and Asia to Latin America, its genetic transformation secondary to inadequate drug exposure and the characteristics of the infected host, and how a change in the healthcare system and tuberculosis control strategies access are needed to change the surge of multidrug resistance tuberculosis.

**Keywords:** tuberculosis, treatment, resistance, Latin, America
