Background: The treatment failure is a health and economic burden as the patient remains a source of infection in the community and it may lead to the development of multidrug resistance. Aim: To assess the risk factors associated with tuberculosis treatment failure among patients with pulmonary tuberculosis. Research design: Exploratory research was utilized. Sample: one hundred and ten adult male and female patients were diagnosed with treatment failure of pulmonary tuberculosis attend to the same setting and aged ranged from 20 to 65 years old. Setting: Chest diseases department & outpatient clinic at Assiut University hospital and chest hospital at Assiut city. Tools: Patient assessment sheet and Patient's Risk factors for treatment failure of pulmonary tuberculosis sheet. Results: show that majority of patient participants had poor knowledge about tuberculosis (86.4%), had inadequate nutrition (78.2%), poor adherence of oral medication (70%), and unsatisfied family support (54.5%) and poor health due to chronic disease (67.3%). Conclusion: Poor knowledge, oral medication adherence and family support are risk factors for treatment failure among patients with pulmonary tuberculosis. Recommendations: It is important to identify risk factors for treatment failure of pulmonary tuberculosis so that appropriate prevention strategies can be implemented and its preventive measures.