Objective To compare the efficacy and safety of moxifloxacin (MXF) and levofloxacin (LVFX) in the treatment of pulmonary tuberculosis patients.Methods A total of 98 patients with pulmonary tuberculosis who visited Pingxiang Second People's Hospital from August 2022 to September 2023 were randomly divided into two groups using a random number table. The LVFX group (n=49) received LVFX treatment, while the MXF group (n=49) received MXF treatment. The clinical efficacy, inflammatory factors, lung function, and adverse reactions between two groups were compared.Results The total effective rate of the MXF group was higher than that of the LVFX group (P＜0.05). After 6 months of treatment, compared with the LVFX group, the MXF group had lower levels of procalcitonin (PCT) and C-reactive protein (CRP), higher forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEF), and FEV1/FVC (P＜0.05). The incidence of adverse reactions in the MXF group [6.12% (3/49)] was lower than that in the LVFX group [22.45% (11/49)]. Conclusion MXF treatment is more effective than LVFX in the treatment of tuberculosis patients, effectively reducing inflammatory reactions, improving lung function, and having fewer adverse reactions.