BCG Flashcards
reduce risk progression bcg sylvester
rrr
arr
managed 3 years
lamm’s regime
24 randomised controlled trials involving 4863 patients with NMIBC. Resulting in an absolute risk reduction of progression of 4% and relative risk reduction of progression of 27% to MIBC. Therefore BCG reduces the risk of progression. 2.5 years foillow up
27% only in maintence arm 16% managed 3 years BCG according to regime 6 x induction, 3 x at 3 months, 6 months, 12 months, 18 months, 24 months, 30, 36 months 27 doses
how give it
do not drink within 4 hours aspirain, anticoag, steroids can affect treatment urinalysis temperature catheter and empy bladder hold 1 hour wee in department
increase fluids 24 hours
no intercourse 48 hours
2 cups of bleach in toilet, wait 15 minutes then flish for first 6 hours, wash hands genitalia after each wee
how many get serious se bcg
Serious side effects are encountered in < 5% of patients and can be treated effectively
symptoms cystitis
nsaid postpone perform urine culture start abx if urine neg culture, quinolones empircally and anti inflamm instillations
symptoms prostatitis
usually asymptomatic
urine culture
quinolones
or RI for 3 months
epididymitis
urine culture
quinolones
stop therapy
ochidectomy if abscess or no response
systemic symptoms 5
general malaise fever athralgia fever BCG sepsis allergic reactions
allergic reaction
anti histamine
anti inflamm
quinolones or RI for symptoms
delay therapy
arthralgia
autoimmune reaction
NSAID
steroids
anti TB drugs
fever more than 48 hours more than 38/5 degrees
permamnent stop
immediate urine culture, cxr., blood tests
antbiotics
infectious diseases
malaise
resolve in 48 hours
bcg sepsis
stop BCG severe infection quinologies or RIE steroids antibiotic cover
bcg failure
whever MIBC refractory if high grade at 3 months cis is at 3 months and 6 months, high grade tumour in BCG
cis at 3 months
responds to another induction BCG in over 50% of cases
BCG relapsing
recurrence high grade after maintenence completion despite initial response
