We conducted an epidemiological and cost analysis for all 13 patients diagnosed with multaidrug-resistant tuberculosis (11 pulmonary, 2 extrapulmonary) in Oman from January 2000 to October 2005. The disease was secondary, or acquired, in 12 of 13 patients. A total of 140 contacts were screened (mean 10.8 persons per patient), but contact tracing revealed no secondary cases. The mean number of drugs that TB isolates were resistant to was 2.8 (range 2–5). A mean of 4.7 drugs were given to patients, the mean length of therapy was 8 months and all patients were cured. The cost of medications for these multidrug-resistant cases was 14 to 29 times higher than that for the standard drug-sensitive TB regimen.