The patient: The onset of fever was in April 2010, and he had hot and sweaty palms and feet after getting cold, accompanied by bilateral lumbar pain, mainly when changing position, with rapid heart rate, not accompanied by chills and chills. Four days ago, he stopped taking anti-tuberculosis drugs and continued to have fever. Recently, the body temperature was 37 to 38 degrees. The chest CT showed diffuse chestnut-like lesions in both lungs. He was diagnosed with “pulmonary tuberculosis type II” at the Affiliated Hospital of Xi’an Jiaotong University. The pathological diagnosis is: granulomatous lesion of small lung tissue in the posterior segment of the lower lobe of the right lung, which is considered as possible tuberculosis. At the present stage, he is receiving continuous infusion of rifampicin 0.6g, etimesine sulfate 0.3g, levofloxacin hydrochloride 0.6g, isoniazid 0.4g. He is taking pyrazinamide tablets three times a day, two tablets a time, transfer factor capsule three times a day, one capsule a time, hepatocyte soft capsule three times a day, two tablets a time, inosine tablets three times a day, two tablets a time, VC three times a day, two tablets a time, B6 three times a day, two tablets a time. Body temperature up to 37.5, using the drug for one month . On July 17, the results of liver function test: glutathione aminotransferase measurement value 65.00, glutathione aminotransferase 67.00, other normal. In the past five days, I have been vomiting a lot during meals, and it gets worse during activities. I would like to ask if it is better to take Rifampin at night before going to bed. When should I take Isoniazid and Heparin? Can I continue to take rifampicin because of high transaminases? Is vomiting with food an adverse effect of rifampicin? Should I stop taking the drug? Should I adjust the dosage after taking the drug for one month? What should I do? The First Affiliated Hospital of Xinxiang Medical College, Department of Tuberculosis Guo Yufeng: 1) Rifampicin works well on an empty stomach, because high protein food affects the absorption of the drug; if taken before bedtime, the diet is not too contraindicated. 2) The national free program requires 4 drugs to be taken at the same time, but elderly patients may be prone to gastrointestinal side effects, isoniazid can be taken early in the morning, and rifampicin is used a few hours apart, the two drugs have little effect on liver function. 3) High transaminases may have the following causes: viral hepatitis? Drug-related liver injury Blood-borne tuberculosis leading to hepatic tuberculosis? Close observation of liver function changes is needed. Please visit the hospital and contact your doctor. We also remind the patient that hematogenous tuberculosis is a systemic tuberculosis, so you should pay attention to the presence of tuberculosis of the brain, meninges, liver, spleen, lymph nodes, etc. Our hospital routinely performs lumbar puncture examinations on hospitalized patients to identify the combination of meningocerebral tuberculosis at an early stage. The commonly used drugs for primary treatment of tuberculosis are isoniazid, rifampin, ethambutol, pyrazinamide, streptomycin, which need to be considered based on the patient’s condition and whether there are other complications, etc. Please contact your doctor for any other suggestions. Patient: Thank you Dr. Guo, can you please tell me if the injectable thymidine can be used? What are the effects and side effects? What kind of medication should I take to protect my stomach from vomiting and hiccups caused by rifampin side effects? The First Affiliated Hospital of Xinxiang Medical College, Department of Tuberculosis, Guo Yufeng: Thymidine can enhance the resistance of the body and is used as an adjunct to the treatment of tuberculosis, but people with allergies may have adverse reactions after using it. Vomiting and hiccups after using rifampin can be treated with metoclopramide or domperidone if the liver function is normal.