There is a patient with chronic hepatitis B. Recently, he has been coughing and feverish for some time, and he visited the respiratory department of the hospital and was diagnosed with tuberculosis, which requires anti-TB treatment, but anti-TB drugs can harm the liver, can they be used? Clinically, we often encounter patients with chronic liver disease (including viral hepatitis, autoimmune liver disease, alcoholic liver disease, fatty liver, schistosomiasis, cirrhosis, etc.) who have combined bacterial infections such as pneumonia, tuberculosis, purulent tonsillitis, pyelonephritis, cholecystitis, appendicitis, peritonitis, etc. and need to receive antibiotic treatment. If the infection is not controlled, bacteria and their toxins can harm the liver directly or indirectly, but antibiotics also have toxic effects on the liver and can cause liver damage if used improperly. How to use antibiotics safely in liver disease patients is a very important issue. The liver is the most important drug that causes liver damage, and they cause hepatocyte damage or bile depression through direct damage or allergic mechanisms, which can be clinically manifested as mildly elevated transaminases, acute hepatitis, fatty liver, and fulminant liver failure. The liver is the largest chemical plant in the body, 90% of antibiotics need to be metabolized and detoxified in the liver, and then excreted out of the body. When the use of antibiotics exceeds the detoxification capacity of the liver, drug liver damage will occur, in liver disease due to poor liver foundation, poor liver function, the use of antibiotics leading to liver damage is more likely, can make the original liver disease relapse or aggravate, serious cases lead to liver failure life-threatening. Second, there are what antibiotics hurt the liver Clinically used antibiotics are divided into the following categories: ① β-lactams: the most varieties, the most widely used, including penicillins and cephalosporins; ② aminoglycosides: streptomycin, gentamicin, butamycin, etc.; ③ macrolides: erythromycin, roxithromycin, leucomycin, azithromycin, etc.; ④ tetracyclines: tetracycline, oxytetracycline, etc.; ⑤ chloramphenicol: that is chloramphenicol; ⑥Lincosamides: lincomycin, clindamycin; ⑦Quinolones: fluoperazine, ofloxacin, lomefloxacin, etc.; ⑧Other antibiotics: vancomycin, capreomycin, rifampicin, etc. Most antibiotics have certain toxic side effects on the liver, and different antibiotic drugs can cause different damage to the liver. For example, most cephalosporins can cause elevated transaminases in high doses; cefoperazone and cefamandole can cause vitamin K deficiency and hypoprothrombinemia, which can easily cause coagulation dysfunction in liver disease; tetracycline can cause toxic fatty liver; macrolides can cause cholestatic hepatitis; the anti-tuberculosis drug isoniazid can cause biliary sludge, and rifampin itself can cause biliary sludge, and has a significant induction effect on liver microsomal enzymes, making The anti-tuberculosis drug isoniazid can cause biliousness, and rifampicin itself can cause biliousness and has significant induction effect on liver microsomal enzymes, which makes isoniazid more toxic and directly damages liver cells; quinolones are mostly metabolized by liver, and liver damage is dose-related; amphotericin B and lincomycin can cause toxic hepatitis. Third, how to use antibiotics correctly ① Patients with liver disease usually do not abuse antibiotics Do not easily use antibiotics for viral colds, for unexplained fever, and do not easily use antibiotics to prevent infection. ②If combined with bacterial infection, it is best to choose antibiotics according to the results of bacterial culture and drug sensitivity test, and try to use drugs with less hepatotoxicity among similar drugs. ③The use of antibiotics should take into account the possible effects of reduced liver function on drug metabolism, and adjust the dose, dosage form and course of antibiotics. ④Liver function needs to be closely monitored during the use of antibiotics, and if liver function abnormalities occur, the treatment plan should be adjusted in a timely manner. ⑤ Must use antibiotics reasonably under the guidance of a doctor, should take the initiative to explain their liver function to the doctor, so that the doctor can avoid those drugs that may cause drug-related liver damage when choosing the medication. In conclusion, antibiotics are like a double-edged sword for patients with liver disease. If used properly, they can control the infection and protect the liver; if used improperly, they can cause drug-related liver damage and aggravate the liver condition. Patients with liver disease must pay attention to the safe use of antibiotics, and should apply antibiotics according to the severity of the disease in a timely manner.