title: Antibiotic and steroid therapy of massive systemic bacillus Calmette-Guerin toxicity.
abstract: Intravesical bacillus Calmette-Guerin (BCG) is the most effective treatment of carcinoma in situ available today and is superior to chemotherapy in the prevention of bladder tumor recurrence. While therapy is generally well tolerated, serious and even life threatening toxicity can occur. Treatment options for serious infection include isoniazid, rifampin, ethambutol, and cycloserine, but shock may also be secondary to hypersensitivity and require the addition of corticosteroids. The morbidity and mortality of systemically BCG-infected mice treated with single and combined antimicrobial and/or corticosteroid therapies was evaluated. BCG immunized mice were unable to survive doses of BCG which were uniformly tolerated in naive mice. The addition of cycloserine increased survival in mice treated with isoniazid and rifampin, but optimal survival was achieved with isoniazid, rifampin, and prednisolone. These experimental results support the previously reported clinical success of isoniazid, rifampin and prednisolone in patients with septic BCG reactions.
authors.affiliation: West Virginia University School of Medicine, Department of Urology, Morgantown 26506.
authors.forename: J I
authors.initials: JI
authors.lastname: DeHaven
authors.forename: C
authors.initials: C
authors.lastname: Traynellis
authors.forename: D R
authors.initials: DR
authors.lastname: Riggs
authors.forename: E
authors.initials: E
authors.lastname: Ting
authors.forename: D L
authors.initials: DL
authors.lastname: Lamm
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D051379:Mice; D011239:Prednisolone / Q000627:therapeutic use*; D015996:Survival Rate; D014376:Tuberculosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D001500:BCG Vaccine; D011239:Prednisolone