Objective To observe the efficacy of prednisone acetate combined with standard quadruple anti-tuberculosis therapy in the treatment of tuberculous pleurisy. Methods: Eighty patients diagnosed with tuberculous pleurisy in the respiratory department of our hospital from March 2022 to March 2024 were selected as the research subjects. Eighty patients were divided into the observation group and the control group by the random number table method, with 40 cases in each group. The control group was treated with the standard quadruple anti-tuberculosis therapy. The observation group was treated with prednisone acetate on the basis of the control group. The therapeutic effects, pleural effusion inflammatory indicators [white Blood Cell Count (WBC), Adenosine Deaminase (ADA)], and blood inflammatory indicators [C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR)] and adverse reactions between the two groups were evaluated and compared. Results: The total effective rate of treatment in the observation group was significantly higher than that in the control group (P < 0.05). After 2 months of treatment, the levels of WBC and ADA in pleural effusion in both groups decreased significantly compared with those before treatment, and the decrease in WBC and ADA in pleural effusion in the observation group was significantly greater than that in the control group ? (P < 0.05). After 2 months of treatment, the CRP and ESR in both groups decreased significantly compared with those before treatment, and the decrease in CRP and ESR in the observation group was significantly greater than that in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: Prednisone acetate adjuvant standard quadruple anti-tuberculosis therapy in the treatment of tuberculous pleurisy can improve the therapeutic effect, reduce inflammation, and has good safety.