Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer
Table 3
Treatment modality of systemic complications induced by intravesical BCG immunotherapy for NMIBC [8, 11, 43, 44, 46, 51, 54, 55, 57].
Systemic complications
Initial therapy
Auxiliary treatment
BCG adjustment
Fever (>38.5°C for more than 48 hours)
300 mg isoniazid, 600 mg rifampin, and 1200 mg ethambutol daily for at least 3 months. Plus an empirical non-specific antibiotic to cover Gram-negative bacteria and/or Enterococcus with or without steroids.
Treatment adapted to urine culture results.
No further BCG
Mycotic Aneurysms
300 mg isoniazid, 600 mg rifampin and 1200 mg ethambutol daily for 12 months
Surgical resection of aneurysms and revascularization (eg extra anatomic bypass or in situ replacement)
No further BCG
Miliary pulmonary tuberculosis
A variety of combined isoniazid, ethambutol, streptomycin, or rifampin for 6 to 12 months
None
No further BCG
Granulomatous hepatitis
300 mg isoniazid, 600 mg rifampin and 1200 mg ethambutol daily for 6 months
Disease-modifying antirheumatic drugs (methotrexate) and/or isoniazid for severe or unimproved cases
BCG can be resumed after benefit-risk assessment till resolution of symptoms; Dose reduction should be considered
Tuberculous Spondylitis
Combined isoniazid, rifampin and ethambutol for 9 to 12 months
Surgical intervention for further complications
No further BCG
BCG sepsis
Emergency admission and intensive care; 300 mg isoniazid, 600 mg rifampin and 1200 mg ethambutol daily for 3 to 6 months; Intravenous 40 mg prednisolone should be given initially and oral steroids taper gradually
