Introduction: Tuberculosis (TB) is an infectious disease that can attack various organs, especially the pulmonary, which is caused by the bacteria Mycobacterium tuberculosis. Mycobacterium tuberculosis can be found through microscopic examination with direct sputum in patients suspected of pulmonary tuberculosis. In addition to the preparation of using direct sputum, smear preparation from material that has been sedimented previously or concentration on microscopic examination is increasing the discovery of acid-resistant bacteria with 4% of NaOH solution. The purpose of this study is to determine the degree of direct sputum AFB smear-positive comparison with sedimentation in patients suspected of pulmonary tuberculosis. Methods: The study design used was analytic research with a cross-sectional approach using direct sputum AFB smear examination with sedimentation in patients suspected of pulmonary tuberculosis. The data were analyzed using the Wilcoxon test, the results of this study showed a significant difference between the direct AFB smear examination with sedimentation which showed the value of p = 0.014. Results: The results of direct sputum AFB smear were negative of 67%, scanty of 4%, positive one of 6%, positive two of 6%, positive three of 17%; results in sedimentation were negative of 64%, scanty of 5%, positive one of 8%, positive two of 5%, positive three of 18%. Conclusion: There was a significant difference between direct sputum AFB smear with sedimentation in patients suspected of pulmonary TB.