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TB PD Peritonitis — ESENeph MCQ

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HardPeritoneal DialysisTB PD PeritonitisESENeph

A 30-year-old woman on PD develops peritonitis. After starting empirical IP antibiotics, cultures grow Mycobacterium tuberculosis. What is the management?

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Correct answer: C — PD catheter removal plus systemic anti-tuberculous therapy for 6-9 months

Tuberculous PD peritonitis is rare but serious. ISPD 2022 guidelines recommend PD catheter removal (TB biofilm makes eradication with the catheter in situ extremely difficult) plus standard systemic anti-tuberculous therapy (typically Rifampicin, Isoniazid, Pyrazinamide, Ethambutol for 2 months then Rifampicin + Isoniazid for 4-7 months). Temporary haemodialysis is needed during treatment. PD catheter reinsertion can be considered after treatment completion. Drug dosing adjustments for CKD are essential (Ethambutol – renal dosing; monitor for Isoniazid hepatotoxicity).

Reference: ISPD 2022 – PD Peritonitis; NICE NG33 2019 – TB