|
| Management options for local side effects |
| Symptomatic granulomatous prostatitis | Symptoms rarely present: perform urine culture. |
| Administer quinolones. |
| If quinolones are not effective, administer isoniazid (300 mg/day) and rifampicin (600 mg/day) for three months. |
| Stop intravesical instillation therapy. |
|
| Epididymo-orchitis | Perform urine culture and administer quinolones. |
| Stop intravesical instillation therapy. |
| Perform orchidectomy if an abscess is present or if there is no response to treatment. |
|
| Management options for systemic side effects |
| General malaise, fever | These generally resolve within 48 hours, with or without antipyretics. |
|
| Arthralgia and/or arthritis | This is a rare complication and is considered an autoimmune reaction. |
| Arthralgia: treat with NSAIDs. |
| Arthritis: treat with NSAIDs. |
| If no/partial response, proceed to treatment with corticosteroids, high-dose quinolones, or antituberculosis drugs. |
|
| Persistent high-grade fever (>38.5°C for >48 h) | Permanently stop BCG instillation. |
| Immediate evaluation: urine culture, blood tests, chest X-ray. |
| Administer prompt treatment with more than two antimicrobial agents while a diagnostic evaluation is conducted. |
| Consult with an infectious disease specialist. |
|
| BCG sepsis | Prevention: initiate BCG at least two weeks after transurethral resection of the bladder (if there are no signs and symptoms of hematuria). |
| Stop BCG instillation. |
For severe infection:
Administer high-dose quinolones or isoniazid, rifampicin, and ethambutol (1.2 g daily) for six months.
Administer early, high-dose corticosteroids as long as symptoms persist.
Consider administering an empirical nonspecific antibiotic to cover Gram-negative bacteria and/or Enterococcus. |
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