Objective: to study tuberculosis treatment outcome of patients under directly observed treatment short course in Azezo health center, North West Ethiopia. Methods: A retrospective study was conducted in Azezo health center by analyzing the data of tuberculosis patients registered from September, 2008 up to August, 2011. Data about patients characteristics and treatment outcome was analyzed using SPSS version 15 and results were summarized in percentages and frequencies presented in tables. Results: The study included 482 tuberculosis patients among whom 50.4% were males and the mean (SD) age was 32.8 (1.6) years. The HIV status of 323 patients was known out of which 38.1% were HIV positive. The trend of tuberculosis over the years studied was steadily increasing. Out of the study subjects 67.8% and 32.2% were pulmonary tuberculosis and extrapulmonary tuberculosis cases, respectively. Successful treatment outcome for all types of tuberculosis cases was 80.5%, being higher for females, smear positive pulmonary cases and HIV negative patients. Sex and HIV status of the patients showed statistically significant association with successful treatment outcome. Conclusion: To improve treatment success rate and minimize the death rate default tracing and home visit made by health extension workers must be strongly implemented as observed in other regions. Enhanced supervision and improved counseling activities also need to be implemented so that the default rate can be minimized for better treatment success rate.