Drugs are a double-edged sword that can both cure and harm patients, and in serious cases even lead to death. In recent years, reports of adverse drug reactions have often appeared in the press, causing widespread concern among medical professionals and even panic among the general public. Adverse drug reactions, has become an increasingly serious problem in front of us. But we should not choke on it. That’s why it is so important to apply the drugs in a way that maximizes their effects and minimizes side effects or toxicity. This requires the joint efforts of doctors and patients. There have been cases where patients with tuberculosis were reluctant to take drugs for fear of adverse effects, so let’s see what happens when you don’t use anti-tuberculosis drugs. In the days before the invention of anti-tuberculosis drugs, the outcome of tuberculosis was not promising, with statistics showing that about 1/3 of patients recovered naturally, 1/3 became chronically ill, and 1/3 died. We can’t bet our health and lives on the 1/3 chance of natural recovery, can we? Thanks to the invention of anti-tuberculosis drugs, the majority of TB patients (more than 90%) can be cured nowadays. Therefore, if you are unfortunate enough to have TB, you must receive anti-TB treatment. Although there are adverse reactions to the drugs, the damage is significantly less than what TB can do to a patient. The principles of anti-tuberculosis drug treatment are early, combination, appropriate dosage and whole course. Early detection and early treatment; the general course of initial TB treatment is 6 months, with at least 3-4 drugs in combination for the first 2 months and at least 2 drugs for the last 4 months; apply a full course of treatment and do not stop early or eat and stop; the dose of each drug should be appropriate, not too large or too small. The problem of adverse reactions to anti-tuberculosis drugs is particularly acute because of the combination of multiple anti-tuberculosis drugs and the long duration of treatment, ranging from 6 months for the shortest cases to 1-2 years for the longest cases (more severe tuberculosis or relapsed tuberculosis requiring a longer course). Therefore, it is very important for doctors treating TB to be familiar with the adverse reactions of various anti-TB drugs and to be skilled in the principles and specific measures for the management of various adverse reactions; and it is also very important for patients to have a general understanding of the adverse reactions of anti-TB drugs and to know where to go for help. We often encounter the problem of adverse drug reactions in the treatment of tuberculosis, which, when handled properly, do not affect much and can cure tuberculosis successfully. However, there are two attitudes of patients that are very wrong: one is to stop all the drugs by themselves when adverse reactions occur; the other is to think that in order to cure tuberculosis, one must insist on taking the drugs, so one continues to take all the drugs regardless of the adverse reactions at all. If you stop the drugs rashly when you encounter adverse reactions, it may lead to treatment failure and become refractory to TB; if you emphasize treatment and do not stop when you must stop the drugs, it may endanger the health and even the life of the patient. In fact, the correct way to deal with an adverse reaction is to suspend taking all the drugs first and then go to the hospital as soon as possible on the same day or the next day to consult with the doctor on how to deal with it. In particular, it is recommended that patients who have been treated and followed up in general hospitals or TB clinics should go to a local hospital specializing in TB treatment and adjust their medication if they have an adverse reaction. Because specialists specializing in the treatment of tuberculosis have more experience and can handle various problems properly, the results are better. Non-specialist doctors or personnel, on the other hand, may not always be able to make decisions that are in the best interest of the patient due to the limitations of their expertise, thus affecting the efficacy of the treatment. Most of the adverse reactions to anti-tuberculosis drugs (about eighty to ninety percent) occur within one month of starting the drug, so especially within one month of starting the drug patients should be observed and discomfort must be considered whether it is an adverse drug reaction and be seen promptly. Let’s understand the adverse reactions of anti-tuberculosis drugs. Gastrointestinal reactions are more common and can be caused by most drugs, but are usually mild and do not require discontinuation of the drug and have little impact on treatment. Liver damage is a more common adverse reaction and affects treatment. The proportion of liver damage occurring during anti-TB is much higher in people with pre-existing liver disease than in those without liver disease. Therefore, people with primary liver disease (e.g., viral hepatitis, cirrhosis, alcoholic liver disease, fatty liver, etc.) should pay attention to simultaneous liver protection and frequently review liver function. Liver damage is usually caused by three different reasons, with different significance and treatment. 1. increased liver burden after medication, short-term maladjustment, transient transaminase elevation, non-stop medication, enhanced liver protection, 1-2 weeks to return to normal; 2. hepatotoxicity of drugs, so that transaminase elevation, not accompanied or accompanied by mild bilirubin elevation. It is more likely to occur in those with primary liver disease. Need to stop the use of drugs with strong hepatotoxicity, such as pyrazinamide, rifampin, prothiouracil, etc. 3. Severe allergic reactions to drugs, with a significant increase in transaminases, accompanied by a significant increase in bilirubin, and may be accompanied by fever (usually high fever) and rash, require immediate discontinuation of the allergy-causing drugs. It is important to note that some liver-protective drugs may also cause or aggravate allergies, so do not abuse them. Drug allergy is another type of adverse reaction that requires our attention. The most common form of manifestation is drug rash, followed by drug fever, and anaphylaxis is rare but very serious and requires immediate resuscitation. A very mild drug rash can subside without stopping the medication and treated with anti-allergy medication. If it does not subside, the milder ones can first stop using the drugs with the highest allergy potential and observe whether the rash subside; the more severe ones or those who are not effective with the above treatment, stop using all drugs, anti-allergic (if necessary, short-term hormones), and try the drugs one by one after the rash has completely subside, starting with the drugs with the lowest allergy potential. Drug fever may or may not be accompanied by a rash, and the most easily misdiagnosed is simple drug fever without a drug rash. Rifamycins are very important anti-tuberculosis drugs, but cause the most adverse reactions, which can cause many types of adverse reactions, including allergic rash, drug fever, gastrointestinal reactions, hepatic impairment, acute hemolytic anemia, acute renal failure, blood leukopenia, and thrombocytopenia. In the case of rifampicin allergy, rash, fever, liver damage and leukopenia can occur at the same time. If a patient has 2 or more of these reactions at the same time, rifampicin allergy should be highly suspected. Some rifampicin-allergic patients are not allergic to rifapentine, so rifapentine can be tried, but start with a small dose and observe closely. Other adverse reactions include eighth to cranial nerve damage (manifested by dizziness, tinnitus, hearing loss, balance disorders), renal damage, optic nerve damage (manifested by blurred vision, visual field defects, etc.), blood leukopenia, thrombocytopenia, and joint pain. Other rare cases include hemolytic anemia, acute renal failure, etc. The doctor should ask the patient about the history of previous medication, allergy and other adverse reactions before the medication is administered. Pay attention to observation during the course of medication, regularly review liver and kidney function, blood routine, urinary routine and other indicators, and inform the patient in detail of the possible manifestations of adverse drug reactions, and instruct him/her to seek medical attention immediately once they occur. As a patient, of course, it is impossible and not necessary to master various adverse reactions and their treatment, as long as the general understanding, discomfort in a timely manner to seek medical advice, do not take matters into their own hands, and leave the problem to professionals to solve it.