Abstract: Objective To evaluate the clinical efficacy of short-course chemotherapy in the treatment of primary recurrence of smear-positive pulmonary tuberculosis. Methods A total of 213 patients with primary recurrent smear-positive pulmonary tuberculosis who were hospitalized in Wenzhou Central Hospital from January 2012 to January 2015 were randomly assigned to a short course (105 patients) and a standard course (108 cases), patients in the short course of treatment were treated with 5MRftPZ regimen, and patients in the standard course of treatment were treated with 2HREZS/6HRE regimen. The negative conversion rate of sputum smear was compared between the two groups at the end of the second month and 9 months after treatment. The total effective rate, lesion diameter and lesion improvement rate were compared between the two groups receiving 9 months of treatment, and the course of treatment was recorded together with adverse reactions. Results There was no significant difference in the sputum smear conversion rate between the two groups (χ²=3.367, P=0.066) and 9 months (χ²=3.045, P=0.080); 9 treatments were treated. The lesion diameter of the short-term treatment group was significantly smaller than that of the standard treatment group (t=7.442, P<0.001). The total effective rate of the short-course group (χ²=4.478, P=0.034) and the improvement rate of the lesion (χ²=6.115, P=0.013) were significantly higher than the standard course of treatment; and the adverse reactions during the treatment of both groups improved after symptomatic treatment, and no serious adverse reactions occurred. Conclusion 5MRftPZ short-course chemotherapy can effectively improve the clinical symptoms, reduce the diameter of tuberculosis patients, improve the clinical treatment efficiency, without obvious adverse reactions, which is safe and effective.