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Evidence summaries

Treating Bcg-Induced Disease in Children

Oral antibiotics might possibly not be effective at reducing the rate of clinical persistence of BCG-induced lesions at 6 to 9 months compared with no intervention or placebo, but the evidence is insufficient. Level of evidence: "D"

The quality of evidene is downgraded by study limitations (unclear allocation concealment and lack of blinding), and by imprecise results (few patients).

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 341 children. Aim of the review was to assess the effectiveness of medical and surgical interventions for treating BCG-induced disease in children. The studies were from Turkey, Iran, and the Caribbean (Jamaica, Dominica). All trials included infants with local/regional lymphadenitis, while two of them also included infants with abscessed lymphadenitis. None of the studies included infants with HIV or other immunodeficiencies. No studies were found including patients with distant/disseminated disease. Four arms compared oral antibiotics to no intervention or placebo, one arm evaluated needle aspiration compared to no intervention, and another evaluated the use of locally instilled isoniazid versus oral erythromycin.

Oral isoniazid, oral erythromycin, or oral isoniazid plus rifampicin did not have an effect on clinical failure. In patients with lymphadenitis abscess, needle aspiration reduced clinically persistent BCG-induced disease at 6 to 9 months of follow-up. In another study of patients with the same condition, aspiration plus local instillation of isoniazid reduced time to clinical cure compared to aspiration plus oral erythromycin (Table T2).

Interventions for BCG vaccine adverse reactions

OutcomeParticipants (studies)No interventionOral isoniazid (INH)Relative effect (95% CI)
Clinical failure54 (2)36 per 10053 per 100 (28 to 100)RR 1.48 (0.79 to 2.78)
OutcomeParticipants (studies)Placebo or no interventionOral erythromycinRelative effect (95% CI)
Clinical failure148 (3)48 per 10047 per 100 (36 to 62)RR 1.03 (0.70 to 1.53)
OutcomeParticipants (studies)No interventionOral isoniazid plus rifampicinRelative effect (95% CI)
Clinical failure35 (1)33 per 10043 per 100 (22 to 82)RR 1.20 (0.51 to 2.83)
OutcomeParticipants (studies)No interventionNeedle aspirationRelative effect (95% CI)
Clinical failure77 (1)35 per 1005 per 100 (1 to 19)RR 0.13 (0.03 to 0.55)
OutcomeParticipants (studies)Oral erythromycinLocally instilled isoniazid
Time to resolution of illness27 (1)The mean time to clinical resolution in the erythromycin group was 5.2 monthsThe mean time to clinical resolution in the isoniazid group was 1.3 months less (95% CI 2.21 less to 0.39 less)

Clinical comments

Note

Date of latest search:

References

  • Cuello-García CA, Pérez-Gaxiola G, Jiménez Gutiérrez C. Treating BCG-induced disease in children. Cochrane Database Syst Rev 2013;(1):CD008300. [PubMed]

Primary/Secondary Keywords