From the Guidelines
The mainstay of treatment for Kawasaki disease is intravenous immunoglobulin (IVIG) combined with Acetylsalicylic acid (ASA), not supportive care alone. The treatment typically involves administering IVIG as a single infusion of 2 g/kg over 10-12 hours within the first 10 days of illness, ideally within the first 7 days, combined with high-dose ASA (80-100 mg/kg/day divided into 4 doses) during the acute phase until the fever resolves, followed by low-dose ASA (3-5 mg/kg/day as a single dose) for 6-8 weeks or until platelet counts and echocardiogram findings normalize 1. IVIG is the cornerstone therapy because it significantly reduces the risk of coronary artery aneurysms, the most serious complication of Kawasaki disease, from approximately 25% to less than 5% 1. While ASA has anti-inflammatory and antiplatelet properties that help manage symptoms and prevent thrombosis, it does not significantly reduce the incidence of coronary artery abnormalities when used alone 1. Some studies suggest that the addition of corticosteroid therapy to IVIG and ASA in the primary therapy of KD may lower the prevalence of coronary artery abnormalities, duration of fever, and inflammation among high-risk patients 1. However, the use of corticosteroids is still being researched and is not yet a standard part of the treatment regimen for all patients with Kawasaki disease. For patients who remain febrile 36 hours after completing IVIG, a second dose of IVIG should be considered, and refractory cases may require additional therapies such as corticosteroids or biologics like infliximab. Key points to consider in the treatment of Kawasaki disease include:
- Administering IVIG and ASA promptly to reduce the risk of coronary artery aneurysms
- Monitoring patients closely for signs of coronary artery abnormalities and adjusting treatment accordingly
- Considering additional therapies such as corticosteroids for high-risk patients or those who do not respond to initial treatment
- Providing ongoing care and follow-up to ensure the best possible outcomes for patients with Kawasaki disease.
From the Research
Treatment of Kawasaki Disease
The mainstay of treatment for Kawasaki disease is a combination of intravenous immunoglobulin (IVIG) and acetylsalicylic acid (ASA), also known as aspirin 2, 3, 4.
Role of IVIG and ASA
- IVIG is proven to decrease the incidence of coronary artery aneurysms from 25% to less than 5% 2.
- ASA is given, although the evidence base is less secure 2.
- The current recommended therapy for Kawasaki disease is the combination of IVIG and ASA 5.
- High-dose IVIG regimens are probably associated with a reduced risk of coronary artery aneurysm formation compared to ASA or medium- or low-dose IVIG regimens 4.
Supportive Care
Supportive care is not the mainstay of treatment for Kawasaki disease, as specific therapies like IVIG and ASA are used to manage the condition 2, 3, 4.
Role of Corticosteroids
- Corticosteroids are effective and well tolerated in Kawasaki disease, both as initial adjunctive treatment in those at high-risk for poor outcome, and as rescue therapy after failed IVIG 6.
- The use of corticosteroids reduced the rates of initial treatment failure among patients who received corticosteroid therapy in combination with IVIG compared to IVIG alone 5.