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Background: Tuberculosis (TB) and under-nutrition has got vicious cycle presence of one can increase the chance of having other. Both are common in under-five children. In spite of many efforts still TB and under-nutrition are most important cause of mortality and morbidity. To get rid from TB it is essential to diagnose and manage TB accurately. Method: A cross sectional observation study was planned to estimate the prevalence of AKT prescription and rationale behind AKT prescription in 204 admitted SAM children in Ujjain block. Result: Total 51% admitted SAM children were put on AKT among them only around 8% children were having the rationale for starting AKT .Chi square test was applied for data analysis. Conclusion: Present study concludes that very few children were prescribed AKT rationally. Is Gap in the TB diagnosis and treatment in children especially in SAM children is resulting in over-prescription of AKT in SAM children. It may be contributing in AKT resistance which is the most deadly problem we are facing with many antibiotics including AKT.