The growing number of reports of antibiotic resistance worldwide has led to fears that some lethal human pathogens, such as Mycobacterium tuberculosis, will soon become untreatable. Here, we show that, although this is possible, it is not inevitable. The World Health Organization has recently reported more cases of multidrug-resistant tuberculosis than ever before, but a new analysis of trend data for 10 groups of countries shows how and why the spread of multidrug-resistant tuberculosis can be reversed by good treatment practices. We find that multidrug-resistant tuberculosis is not self-sustaining in 9 out of the 10 settings and conclude that multidrug-resistant tuberculosis can be set on a path--albeit a slow path--to elimination. This result applies even to countries such as Estonia and Latvia, which have exceptionally high prevalence rates of multidrug-resistant tuberculosis.