OBJECTIVES: Despite the availability of highly efficacious pharmacotherapy, tuberculosis (TB) still remains as a major public health problem globally. The aim of the present study was to evaluate TB treatment outcomes in four high burden TB states of Malaysia METHODS: This was a retrospective prospective study conducted at TB clinics of Penang, Sabah, Sarawak and Selangor. All TB patients who were presented to the clinics from January 2006 to December 2008 were included in the study. A purpose developed valid data collection form was used for collecting demographic and clinical data. World Health Organization (WHO) defined criteria was used for defining treatment outcomes.  Data was analyzed by using SPSS 16®.  RESULTS: Final analysis included 9337 patients. Mean age of patients was 41.75 + 10.11 years. Sixty nine percent patients were males. Treatment success rate was 77.5% (n = 7240).  Among 7240 successfully treated patients, 5319 patients cured while 1921 completed their treatment. Among 22.5% (n=2097) unsuccessfully treated patients, 503 died, 502 defaulted, 369 transferred out and 723 were on treatment continued. In multivariate analysis new TB infection (OR=1.315, p-value<0.001) was the only factor associated with successful treatment outcome. Whereas extra pulmonary TB (OR=0.541, p-value<0.001), pulmonary + extra pulmonary TB (O =0.523, p-value<0.001), urban area (OR=0.889, p-value=0.030), smoking (OR=0.890, p-value=0.030), alcohol consumption (OR=0.807, p-value=0.011) intravenous drug use (OR=0.676, p-value<0.001) and employment (OR=0.507, p-value<0.001) had statistically significant negative association with successful treatment outcome. CONCLUSIONS: Although more than three fourth (77.5%) patients were treated successfully but the treatment success rate is still behind the WHO target of 85%. In future more attention should be paid to patients with extra pulmonary TB, belonging to urban area, smokers, alcohol consumers, intravenous drug users and employees