Tailoring antitubercular therapy in a critically ill patient with abdominal tuberculosis

Abdominal tuberculosis may present acutely as peritonitis or intestinal perforation, which might need immediate surgical intervention and postoperative intensive care. Even in rifampicin-sensitive tuberculosis, standard first-line oral antitubercular therapy might be ineffective due to the unreliable gastrointestinal absorption and altered pharmacokinetics. We report a case of a young woman with abdominal tuberculosis and multiple ileal perforations who required intensive care following emergency laparotomy. We used an initial antitubercular treatment with the combination of intravenous amikacin, linezolid and levofloxacin until intestinal function recovered. She was then transitioned to standard oral therapy with rifampicin, isoniazid, pyrazinamide and ethambutol, achieving full recovery. This case highlights the value of short-term parenteral antitubercular regimens as a bridge in critically ill patients with gastrointestinal compromise, underscoring the role of pharmacokinetic considerations and multidisciplinary care.