Intravesical bacillus Calmette-Guerin (BCG) is widely used for the tre
atment of transitional cell carcinoma of the bladder. Although it is u
sually well tolerated, sepsis can occur, which has resulted in at leas
t eight deaths [3]. The survival of Connaught BCG-infected mice treate
d with single and combination antibiotic and steroid therapy was evalu
ated. Triple-drug therapy with isoniazid, rifampin, and prednisolone r
esulted in 53% survival compared with 25% survival in the control grou
p (P=0.0209). A survival of only 10.5% was observed with treatment usi
ng prednisolone alone. This survival was worse than that of the contro
l group (25%), and approached statistical significance (P=0.0669). Our
data suggest that BCG sepsis probably has components of both a hypers
ensitivity reaction and bacterial sepsis; they support the current use
of combination antibiotic and steroid therapy for treatment of BCG se
psis in humans, but argue against treatment with steroids alone.