Systematic review of antimycobacterial therapy for Bacille Calmette-Guérin infection in hosts without significant immunocompromise

Objectives
This systematic review aims to synthesise the best available evidence on antimycobacterial management of Bacille Calmette-Guérin (BCG) infection in hosts without significant immunocompromise.

Methods
We performed a systematic review searching Medline, Scopus, Cinahl, Global Health and Clinicaltrials.gov, including the best available evidence on antimycobacterial management of BCG infection after any route of BCG administration. We analysed these subgroups: local and disseminated infection after intravesical instillation, osteitis after vaccination and central nervous system (CNS) infection.

Results
17 studies were included with 131 patients (one prospective and 16 retrospective cohort). For infection after intravesical instillation, in line with the Summary of Product Characteristics, triple therapy was most common in disseminated infection (75.0%, (38/52)), but for local infection only 37.5% (6/16) of patients received dual therapy. Osteitis was usually managed with a dual regimen ((68.3%, 43/63); although cure rates were high, 33.3% (21/63) of patients experienced an adverse outcome. CNS infections were typically treated with a quinolone-based three- or four-drug regimen.

Conclusions
Triple therapy for disseminated infection after intravesical instillation is likely sufficient but we are unable to conclude an optimal regimen for local infection. Although cure rates were high for dual therapy in osteitis, further work is needed to understand morbidity. Future studies should be of higher quality and include standardised reporting of clinical outcomes.