The aim was to determine the difference in distribution of biomedical factors between smear positive and smear negative TB and to audit some aspects of management practices in Mahalla Chest Hospital, Egypt. A retrospective analysis for tuberculous records admitted during 2013. Smear positive and smear negative TB cases were similar regarding biomedical profile. Time needed to reach diagnosis among smear negative TB patients was significantly prolonged than positive one. TB screen is not asked directly in 88.9% once the patients suffered from chest symptoms for > two weeks. 16.4% of diagnosed TB cases were done without making x ray in the hospital. In spite of 25.7% and of smear negative was not subjected to antibiotic therapy and 37.8% of them were not perform sputum smear or perform only one smear sample; the TB committee decided to treat these cases as TB. Ongoing audit to find service gaps and a medical training program as well as regular supervision of all processes of TB management were recommended.