What is the treatment for Kawasaki disease?

From the Guidelines

Kawasaki disease treatment typically involves the administration of intravenous immunoglobulin (IVIG) at a dose of 2 grams per kilogram, infused over 12 hours, in conjunction with high-dose aspirin at 80-100 mg/kg/day, divided into four doses, for the initial 14 days of treatment 1.

Key Treatment Components

• IVIG: 2 grams per kilogram, single infusion 1
• High-dose aspirin: 80-100 mg/kg/day, divided into four doses, for the initial 14 days of treatment 1

Additional Considerations

• For patients who do not respond to initial IVIG treatment, a second dose of 2 grams per kilogram may be administered 1
• Aspirin is continued at a lower dose of 3-5 mg/kg/day for a total duration of 6-8 weeks, or until inflammation has resolved 1
• Corticosteroids, such as prednisolone, may also be considered as adjunctive therapy in cases of IVIG-resistant disease 1

Important Notes

• The treatment should be initiated within 10 days of fever onset if possible 1
• The concomitant use of ibuprofen should be avoided in children with coronary aneurysms taking aspirin for its antiplatelet effects 1

From the Research

Treatment Overview

The treatment for Kawasaki disease typically involves a combination of medications to reduce inflammation, prevent coronary artery aneurysms, and manage symptoms.

• Intravenous immunoglobulin (IVIG) is a key component of treatment, with a recommended dose of 2 g/kg administered over 10-12 hours 2, 3.
• Aspirin is also commonly used for its anti-inflammatory and antipyretic effects, although its role in preventing aneurysms is less clear 2, 3.

Adjunctive Therapies

For patients at high risk of developing aneurysms or those who do not respond to initial IVIG treatment, adjunctive therapies may be considered.

• Corticosteroids, such as methylprednisolone, may be used as an alternative rescue therapy for immunoglobulin-resistant Kawasaki disease 4.
• Other immunomodulatory therapies, including infliximab, cyclosporine, and cyclophosphamide, may also be used in certain cases 2.
• A combination of IVIG and prednisolone may be effective as a first-line rescue therapy for IVIG nonresponders 5.

Antithrombotic Therapies

Antithrombotic therapies are tailored to the individual patient's risk of thrombosis.

• Aspirin alone may be sufficient for patients without aneurysms, while those with giant aneurysms may require a combination of anticoagulation and antiplatelet therapy 2.

Dosage and Administration

The dosage and administration of IVIG can vary, with some studies suggesting a moderate dose of 1 g/kg may be effective, although a high dose of 2 g/kg is generally recommended 2, 6.

• The timing of corticosteroid treatment has been widely discussed, with some evidence suggesting its use as an adjunctive primary therapy, especially in high-risk patients 4.