[Antibioprophylaxis failure with BCG therapy for bladder neoplasia]

BCG therapy is the standard treatment for bladder tumors that do not infiltrate smooth muscle. Fluoroquinolones for antibiotic prophylaxis are recommended to lessen the risk of BCG infection (BCGitis) with respiratory involvement.

This study describes five cases of BCGitis in males, with a median age of 71years [range: 66-77years] having undergone ofloxacin prophylaxis during their BCG therapy for a non-invasive bladder tumor (grade pT1a). Among these patients, four experienced fever within eight hours of the last instillation, as well as respiratory symptoms such as dyspnea and cough. Three of them exhibited substantial weight loss over the course of one month. Chest scans consistently revealed miliary patterns. While only in one patient was BCG identification confirmed, typical clinical and CT presentations prompted the initiation of treatment, predominantly employing a combination of isoniazid, rifampicin, and ethambutol in four patients, and isoniazid and rifampicin in the fifth. Treatment duration ranged from six to nine months. One-year follow-up indicated a favourable outcome for all patients.

This study shows that ofloxacin prophylaxis may in some cases fail to prevent iatrogenic BCGitis.