Bacillus Calmette-Guérin (intravesical)

How it works

It induces a local immune and inflammatory response in the bladder wall that exerts an anti-tumour effect against superficial bladder cancer cells.

Prescribing in practice

• Because it is a live organism it can cause local and, rarely, disseminated BCG infection, so it must not be given where there is bladder trauma, haematuria or immunosuppression.
• It is administered by bladder instillation under specialist urology supervision following defined schedules.
• Healthcare staff must handle and dispose of the preparation and contaminated urine using appropriate precautions.

Monitoring

Monitor for local cystitis-type symptoms and for systemic features suggesting BCG infection, such as persistent fever or malaise.

Counselling the patient

• Expect urinary frequency and discomfort for a short period after instillation; report persistent fever or worsening symptoms.
• Follow the advice given on toileting hygiene after treatment to limit exposure of others.

Evidence & guidelines

Intravesical BCG is a long-established standard treatment for high-risk non-muscle-invasive bladder cancer supported by extensive clinical evidence.