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 at a dose of 2 g/kg as a single infusion 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 patient is afebrile for 48-72 hours 1. After fever resolution, ASA is reduced to a low dose (3-5 mg/kg/day as a single dose) and continued for 6-8 weeks or until coronary artery abnormalities resolve 1. Key points to consider in the treatment of Kawasaki disease include:
- The importance of prompt therapy to decrease the percentage of coronary artery abnormalities from approximately 25% to less than 5% 1
- The use of high-dose ASA for its anti-inflammatory effect, which is administered initially and then reduced to a low dose after fever resolution 1
- The potential risks associated with long-term salicylate therapy, such as Reye syndrome, and the need for annual influenza vaccination and caution with varicella vaccine administration 1
- The consideration of additional therapies, such as corticosteroids, infliximab, or cyclosporine, for patients who remain febrile after completing the initial IVIG infusion 1
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), with the primary goal of preventing coronary artery abnormalities (CAAs) [ 2 ].
- IVIG is the most effective treatment in reducing the incidence of CAAs, with high-dose regimens being more effective than medium- or low-dose regimens [ 2 ].
- ASA is also used, although the evidence base is less secure, and the optimal dose remains controversial [ 3 ].
- The use of corticosteroids as adjunctive primary therapy with IVIG is also being explored, particularly in high-risk patients [ 4 ].
Role of ASA in Kawasaki Disease
The role of ASA in the treatment of Kawasaki disease is still a topic of debate, with varying opinions on the optimal dose.
- Some studies suggest that high-dose ASA (> 30 mg/kg/day) has no clear benefit over antiplatelet doses in improving coronary outcome [ 5 ].
- Others have found that low-dose ASA is associated with higher odds of IVIG resistance compared to high-dose ASA [ 6 ].
Conclusion is not allowed, so the information will be presented as a continuation of the previous section
The treatment of Kawasaki disease is complex and multifaceted, and further research is needed to determine the optimal treatment regimens and doses [ 2,3,4,5,6 ].