DRUG-THERAPY OF BACILLUS-CALMETTE-GUERIN SEPSIS

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.