The emergence of MDR-TB and, more recently, of MDR-TB is widely regarded as a severe threat to global TB monitoring. TB is a major threat to the development of multidrug-resistant TB. Every year, there are more than 400,000 new cases of MDR-TB and, while currently unknown, XDR-TB cases in every country where they are capable of being identified have been detected. This article gives a narrative overview of various diagnostic options for XDR-TB, including standard tools and new fast drug resistance tests. Data available reinforce the high precision and rapidly growing use of automatic liquid cultivations. TK Medium microscope monitoring medication-susceptibility assessment, bacteriophage test for FAST Plaque-Response, methods for colorimetric redox indicators and method for microcolonies, are newly developed phenotypical testing. Such tests are typically cheaper, but are not always easy to conduct and some claim high biosafety and quality control standards. Reverse hybridization-driven assays, known as line tests, are a useful tool because their high precision and economic efficiency are among the newly developed phenotypic methods. The threats of MDR-TB and XDR-TB, global efforts to scale culture and drug susceptibility testing capacity are required to address effectively, especially in high-capacity countries. Parallel efforts are expected to extend the usage for the fast determination of drug resistance of existing and emerging technologies (e.g., molecular diagnosis).