From the Guidelines
The primary treatment for Kawasaki disease is intravenous immunoglobulin (IVIG) and aspirin, with IVIG administered as a single infusion of 2g/kg over 10-12 hours within the first 10 days of illness, as recommended by the American Heart Association 1. High-dose aspirin (80-100mg/kg/day divided into four doses) is given during the acute phase while the patient has fever, then reduced to low-dose aspirin (3-5mg/kg/day as a single dose) once the fever resolves. Low-dose aspirin is continued for 6-8 weeks if no coronary artery abnormalities develop, or longer if coronary artery abnormalities are present. For patients who don't respond to initial IVIG (persistent or recurrent fever 36 hours after completion), a second dose of IVIG may be given, as suggested by the American Heart Association 1. Some cases may require additional treatments like corticosteroids, infliximab, or cyclosporine, although the effects of these treatments on coronary artery abnormalities are still uncertain, as noted in a study by Kato et al 1. Early treatment is crucial as it significantly reduces the risk of coronary artery aneurysms, the most serious complication of Kawasaki disease, with a reduction in incidence from 25% to approximately 4% with prompt therapy, as reported by McCrindle et al 1. Treatment should be initiated promptly upon diagnosis, as delays increase the risk of cardiac complications. Patients should be monitored with echocardiograms at diagnosis, 1-2 weeks later, and 4-6 weeks after onset of illness to assess for coronary artery abnormalities, as recommended by the American Heart Association 1. Key considerations in the treatment of Kawasaki disease include:
- Prompt initiation of treatment with IVIG and aspirin
- Monitoring for coronary artery abnormalities with echocardiograms
- Consideration of additional treatments for patients who do not respond to initial IVIG
- Long-term management to prevent cardiac complications, as outlined in the American Heart Association guidelines 1.
From the Research
Treatment Options for Kawasaki Disease
The treatment for Kawasaki disease typically involves a combination of medications to reduce inflammation and prevent complications. The standard initial therapy includes:
Adjunctive Therapies
For patients who do not respond to initial therapy, adjunctive therapies may be considered, including:
High-Risk Patients
For high-risk patients, primary adjunctive therapy with corticosteroids may be considered to reduce the risk of coronary artery abnormalities 6.
Treatment Goals
The goals of treatment for Kawasaki disease are to:
- Reduce the risk of coronary artery complications 2, 3
- Improve clinical outcomes 2
- Prevent thrombosis 4
- Reduce systemic inflammation 4
Ongoing Research
There is ongoing research into the use of new therapies and the optimization of existing treatment regimens for Kawasaki disease 2, 3, 5.