Inclusion of Pyrazinamide (PZA) in Tuberculosis (TB) chemotherapy has significantly shortened the treatment duration to 6 months. This is the only drug which is used in the treatment of both drug sensitive as well as Multi Drug Resistant (MDR) form of Tuberculosis. Although resistance to PZA is associated with poor treatment outcome Drug Susceptibility testing (DST) of PZA is not routinely performed due to technical difficulties in public health laboratories in India. The current study was undertaken to determine the proportion of PZA resistance in MDR and Non MDR TB and to propose the most feasible test that can be adopted for detecting PZA resistance. Sputum samples from 117 MDRTB suspects were tested for multi drug resistance using Line Probe Assay (LPA) and PZA DST was performed by MGIT and Pyrazinamidase enzyme activity was analyzed. 6.8% of the samples tested were MDR and almost 43% of them were resistant to Pyrazinamide. The pncA gene was sequenced for all isolates exhibiting phenotypic resistance. Nearly half of the MDRTB cases were resistant to PZA, indicating the need to customize the MDRTB regimen based on the PZADST result.