Treating tuberculosis (TB) remains a public health challenge in many developing countries. A retrospective cohort study was conducted on notified pulmonary TB cases in Kota Bharu district of Kelantan, Malaysia. Simple and multiple logistic regressions analysis were performed to identify factors associated with unsuccessful treatment outcomes.In univariable analysis, age, sex, educational level,employment status, family incomes as well as co-existence of extra-pulmonary TB, smoking, co-morbid diseases, HIV status, sputum cultures, chest X-ray findings and duration of delay were all found to have significant relationship with unsuccessful pulmonary TB treatment outcome. After adjusted for the confounders using multiple logistic regression analysis, the significant associated factors were age, positive HIV and advanced chest X-ray findings. This book discussed the associated factors for unsuccessful tuberculosis treatments which can guide the policy makers in the country to give more focus and priority among these high risks group of patients including strengthening the Directly Observed Treatment Short-course strategy.