Taking levofloxacin for pulmonary tuberculosis belongs to the second-line treatment regimen for tuberculosis, which indicates that the patient has drug resistance in the course of the first-line treatment regimen, clinical symptoms such as cough, coughing, hot flushes and night sweats, blood in sputum, especially the lack of obvious absorption of lesions on imaging, and repeated positive sputum tests for antacid bacilli suggest the need to change to the second-line treatment regimen. Levofloxacin is a fluoroquinolone antibiotic with dual action against Gram-negative bacilli and Gram-positive cocci, which is of special significance in the treatment of drug-resistant tuberculosis. Combined with Rickettsia pulmonary disease and other anti-tuberculosis drugs together to give second-line treatment, the course of treatment is long, pay attention to whether liver function damage occurs in the process of taking the drug, patients younger than 18 years old can not take levofloxacin to avoid affecting growth and development. In conclusion, levofloxacin for tuberculosis requires close monitoring of liver function in order to minimize toxic side effects.