1704Optimal treatment of BCG Osteomyelitis: A Review

Background. There are few data about the optimal drug regimen and duration of therapy for Bacillus Calmette-Guerein (BCG) osteitis. Methods. We searched Medline using terms: Mycobacterium bovis, immunization, BCG vaccine, osteitis, and bone diseases; infectious. Exclusion criteria were; non-English, single case report, intravesicular BCG, non-human subjects, and insufficient description of treatment and complications. Results. Our search yielded 66 studies, with 6 case series (n = 2-222), the cumulative total was 261 patients. Median onset of BCG osteitis was 1 year post-vaccination (3-26 months). The lower extremity was the most common site. Most cases were immune-competent, however variations in the interferon-gamma receptor (n = 6), and mannose-binding lectin (n = 56) genotypes were found. Surgical biopsy was performed in 255 cases, diagnosis was via culture in 135 cases, pathology in 227 and exclusively clinical/radiologic in 6. TB skin tests were positive in 95 cases. The number of patients who underwent surgical debridement is unclear. Drug therapy usually included an early intensive phase of 2 months, followed by consolidation therapy for a total duration of 6-24 months. Drug combinations included INH, Rifampin, and a third drug, 13 cases received <3 effective drugs. No definite association between duration, drug regimen, and complication rate could be discerned (table). Complications occurred in 5%, including fistulae, abscess formation, and further surgical intervention, relapses occurred in 2%. The largest series reported complications in 3%.