From the Guidelines
Isoniazid (INH) treatment is not recommended for Bacillus Calmette-Guérin (BCG) adenitis, as most cases resolve spontaneously without specific treatment. The provided evidence [ 1, 1 ] does not support the use of INH for BCG adenitis. Instead, observation is the preferred approach for non-suppurative (non-draining) BCG adenitis. For suppurative adenitis that has progressed to fluctuation or drainage, needle aspiration may be performed to prevent sinus tract formation and hasten recovery.
Some key points to consider:
- BCG adenitis is a localized lymph node reaction following BCG vaccination, and most cases resolve within 2-6 months without specific treatment [ 1 ].
- Anti-tuberculosis medications, including INH, are typically reserved for severe or disseminated BCG infections, which are rare complications.
- When treatment is deemed necessary for severe cases, a combination of INH with rifampin for 3-6 months may be considered, but this approach is based on the understanding that BCG is a live attenuated strain of Mycobacterium bovis with inherent resistance to pyrazinamide but susceptibility to other first-line anti-TB drugs [ 1 ].
- The risk-benefit ratio rarely favors medication use since most cases resolve without intervention, and the medications themselves carry potential side effects, including hepatotoxicity.
In terms of treatment regimens, the evidence suggests that:
- For children and adolescents, isoniazid given either daily or twice weekly for 9 mo is the recommended regimen for latent tuberculosis infection [ 1 ].
- For contacts of patients with isoniazid-resistant, rifampin-susceptible TB, rifampin and pyrazinamide given daily for 2 mo is recommended [ 1 ]. However, these regimens are not recommended for BCG adenitis, and treatment should be individualized based on the severity of the infection and the patient's overall health status.
From the Research
Treatment of BCG Adenitis
- Isoniazid (INH) is used to treat Bacillus Calmette-Guérin (BCG) adenitis, as stated in the study 2, where it is used to control symptoms, prevent progressive infection, and avoid the overgrowth of BCG.
- The use of INH in treating BCG-induced disease in children is uncertain, as reported in the study 3, with very low quality evidence showing no significant effect on clinical failure.
- In cases of suppurative lymphadenitis caused by BCG vaccination, adjuvant medical treatment with anti-TB medications, including INH and Rifampicin, may be administered for 3 months, as described in the study 4.
- The effectiveness of INH in shortening the therapy period for BCG lymphadenitis is questionable, as shown in the study 5, where no significant difference was found between groups treated with INH and those without.
- Medical therapy, including INH, may not be effective in preventing drainage and suppuration in regional lymphadenitis following BCG vaccination, as reported in the study 6, with no significant superiority of any specific therapy shown.
Forms of BCG Adenitis
- Suppurative lymphadenitis is a severe complication of BCG vaccination, and its treatment may involve surgical excision and adjuvant medical therapy with INH and Rifampicin, as described in the study 4.
- Regional lymphadenitis following BCG vaccination can be treated with total surgical excision, which is the best therapy for suppurative forms, as shown in the study 5.
- The incidence of spontaneous drainage and suppuration in regional lymphadenitis following BCG vaccination may be higher in cases where lymphadenitis develops rapidly, as reported in the study 6.