Table 3.

Treatment modality of systemic complications induced by intravesical BCG immunotherapy for NMIBC [8, 11, 43, 44, 46, 51, 54, 55, 57].

Systemic complications	Initial therapy	Auxiliary treatment	BCG adjustment
Fever (>38.5°C for more than 48 hours)	300 mg isoniazid, 600 mg rifampin, and 1200 mg ethambutol daily for at least 3 months. Plus an empirical non-specific antibiotic to cover Gram-negative bacteria and/or Enterococcus with or without steroids.	Treatment adapted to urine culture results.	No further BCG
Mycotic Aneurysms	300 mg isoniazid, 600 mg rifampin and 1200 mg ethambutol daily for 12 months	Surgical resection of aneurysms and revascularization (eg extra anatomic bypass or in situ replacement)	No further BCG
Miliary pulmonary tuberculosis	A variety of combined isoniazid, ethambutol, streptomycin, or rifampin for 6 to 12 months	None	No further BCG
Granulomatous hepatitis	300 mg isoniazid, 600 mg rifampin and 1200 mg ethambutol daily for 6 months	None	No further BCG
Reactive arthritis	Non-steroidal anti-inflammatory drugs ± corticosteroids	Disease-modifying antirheumatic drugs (methotrexate) and/or isoniazid for severe or unimproved cases	BCG can be resumed after benefit-risk assessment till resolution of symptoms; Dose reduction should be considered
Tuberculous Spondylitis	Combined isoniazid, rifampin and ethambutol for 9 to 12 months	Surgical intervention for further complications	No further BCG
BCG sepsis	Emergency admission and intensive care; 300 mg isoniazid, 600 mg rifampin and 1200 mg ethambutol daily for 3 to 6 months; Intravenous 40 mg prednisolone should be given initially and oral steroids taper gradually	Broad-spectrum antibiotics as needed	No further BCG