From the Guidelines
The recommended treatment for Kawasaki disease is intravenous immunoglobulin (IVIG) at a dose of 2 g/kg as a single infusion, along with high-dose aspirin (80-100 mg/kg/day divided into four doses) during the acute phase. This treatment should be initiated within the first 10 days of illness, ideally within 7 days, to reduce the risk of coronary artery abnormalities 1. The use of IVIG has been shown to reduce the prevalence of coronary artery aneurysms from 25% to less than 5% 1.
Some key points to consider in the treatment of Kawasaki disease include:
- Treatment should be initiated as soon as possible, ideally within 7 days of illness onset, to maximize the effectiveness of IVIG in reducing coronary artery abnormalities 1.
- Aspirin should be given in high doses (80-100 mg/kg/day) during the acute phase, and then reduced to a low dose (3-5 mg/kg/day) after the fever resolves 1.
- For patients who remain febrile or have persistent inflammation 24-36 hours after completing IVIG, a second dose of IVIG may be given 1.
- In refractory cases, additional treatments such as corticosteroids, infliximab, cyclosporine, or anakinra might be considered 1.
- All patients should have baseline and follow-up echocardiograms to monitor for cardiac complications 1.
It's worth noting that the most recent and highest quality study, published in 2017, provides the most up-to-date guidance on the diagnosis, treatment, and long-term management of Kawasaki disease 1. This study emphasizes the importance of prompt treatment with IVIG and aspirin, as well as the need for ongoing monitoring and management to prevent long-term cardiac complications.
From the Research
Kawasaki Disease Treatment
The recommended treatment for Kawasaki disease includes:
- Intravenous immunoglobulin (IVIG) as the primary therapy in the acute stage of the disease 2, 3
- High-dose aspirin is often administered, but its necessity is still being evaluated 2
- The American Heart Association (AHA) recommends a single infusion of 2 g/kg of IVIG preferably given during the first 10 days of illness 3
IVIG Treatment Regimens
Different studies have reported various treatment regimens of IVIG, including:
- A moderate dose (1 g/kg) of IVIG, which has been shown to be less effective than a high dose regimen (2 g/kg) in preventing coronary artery lesions (CAL) 4
- A high dose (2 g/kg) of IVIG, which is recommended by the AHA and has been shown to be effective in reducing the frequency of coronary artery abnormalities 3, 5
Predicting Treatment Resistance
Machine learning models have been used to predict resistance to consecutive IVIG treatments, with key predictors including:
- Absolute neutrophil count (ANC)
- Serum protein levels
- Platelet count
- C-reactive protein (CRP) levels 6
Treatment Outcomes
The outcomes of Kawasaki disease treatment have been evaluated in several studies, with results showing that: