Intravesical Immunotherapy
Pregnancy: Not applicable in urology indication
Bacillus Calmette-Guerin (BCG)
Brand names: ImmuCyst, OncoTICE
Adult dose
Dose: One vial (81 mg OncoTICE or equivalent) intravesically weekly for 6 weeks (induction)
Route: Intravesical instillation
Frequency: Weekly for 6 weeks induction; then maintenance (3-weekly for 3 weeks at 3, 6, 12, 18, 24, 30, 36 months)
Max: One vial per instillation
Patient must retain BCG in bladder for 2 hours. Rotate position (lying, standing) to expose all mucosal surfaces. Void BCG with bleach for 6 hours after instillation (infection precaution). Do not instil if traumatic catheterisation or active UTI
Paediatric dose
Dose: Not applicable N/A/kg
Route: Intravesical
Frequency: Not applicable
Max: Not applicable
Not applicable
Dose adjustments
Renal
No dose adjustment (local therapy)
Hepatic
No dose adjustment
Paediatric weight-based calculator
Not applicable
Clinical pearls
- Gold standard intravesical treatment for high-risk non-muscle-invasive bladder cancer (NMIBC: high-grade T1, CIS, high-risk Ta) — superior to mitomycin C for recurrence prevention and progression
- BCG sepsis is rare but life-threatening — presents with fever above 38.5 for over 12 hours, rigors, hypotension; treat with rifampicin, isoniazid, and ethambutol (not standard antibiotics, which are ineffective against BCG) plus corticosteroids; ITU involvement
- Never instil BCG if traumatic catheterisation (blood visible) — risk of systemic BCG absorption is dramatically increased
- NICE NG2: Offer BCG induction + 1-3 years maintenance to all patients with high-risk NMIBC after TURBT
- BCG shortage has been an ongoing supply issue globally — contact regional oncology pharmacists if supply disrupted
Contraindications
- Active UTI (risk of systemic BCG sepsis)
- Haematuria (traumatic catheterisation)
- Immunosuppression
- Active TB
- Bladder perforation or recent TURBT within 2 weeks
Side effects
- Cystitis symptoms (very common — dysuria, frequency, urgency)
- Haematuria
- Flu-like symptoms
- BCG sepsis (rare, life-threatening — systemic dissemination)
- Granulomatous hepatitis, pneumonitis (rare systemic effects)
- Epididymo-orchitis
Interactions
- Antimicrobials reduce BCG efficacy (avoid antibiotics for 2 days before and after instillation unless treating UTI)
Monitoring
- Cystoscopy (3-monthly in first year, then 6-monthly — recurrence surveillance)
- Urine culture before each instillation
- Symptoms of systemic BCG infection (fever, night sweats)
Reference: BNFc; BNF 90; NICE NG2 (Bladder Cancer); EAU Bladder Cancer Guidelines 2024; SWOG S8507 Trial. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators