This study conducted to evaluate the role of pretreatment bacillary load in predicting multi drug resistance tuberculosis (MDR-TB). Sputum smear positive cases of all pulmonary tuberculosis, who received standard short course chemotherapy under direct observation, were studied with pretreatment absolute acid fast bacilli (AFB) counts per 100 oil immersion fields and culture-sensitivity assay for Mycobacterium tuberculosis. Pretreatment count of > or = 850 bacilli per oil immersion field in category II cases and > or = 1200 bacilli per oil immersion field in category I cases was found to be a predictor of MDR-TB with sensitivity and specificity of 88.89% and 87.04% in category II; and 100% and 84.13% in category I subjects respectively. In conclusion, high bacillary count (3+) can be taken as a marker of MDR-TB, specially in treated cases of tuberculosis and requiring further investigation as well management of these cases on lines of multi drug resistance tuberculosis.