Treatment of Kawasaki Disease
Aspirin and intravenous immune globulin (IVIG) have been the standard therapy for Kawasaki
disease for many years.
Aspirin
High-dose aspirin (80-100 mg/kg/day, divided into four doses) is administered for its antiinflammatory
properties.
Aspirin shortens the febrile course of the illness but has no effect on the development of
aneurysm.
Following defervescence, low-dose aspirin (3-5 mg/kg/day given in a single dose) is
administered for its anti-platelet effects.
Aspirin is discontinued altogether after a total of six to eight weeks if no coronary artery
changes are seen in follow-up echocardiograms. If there are coronary artery abnormalities,
low dose aspirin is continued indefinitely as an anti-platelet agent.
Aspirin and Reye syndrome: Children taking aspirin are at risk for experiencing Reye syndrome (a
potentially fatal illness that causes multi-organ damage) if infected with certain viruses, including
influenza virus A or B; therefore, physicians should be particularly vigilant about recommending
influenza vaccination for children receiving long-term aspirin therapy.
IVIG
The use of IVIG in Kawasaki disease has decreased the incidence of coronary artery
aneurysms from 20-25% to 2-4%.
A single dose of IVIG at a dose of 2 g/kg administered over ten to twelve hours has been
shown to be more effective in reducing the risk of coronary artery aneurysms than multiple
lower doses
Other antipyretics are usually not effective for fever control. Furthermore, use of ibuprofen has been
shown to antagonize the irreversible platelet inhibition induced by aspirin and therefore should be
avoided in children with coronary aneurysms taking aspirin for its antiplatelet effects.
Antibiotics have not been shown to have any effect on the clinical course.
The role of steroids is unclear. For years, steroids were felt to have no role, or even to be
12/15
detrimental. Newer studies suggest that they may have a role in the acute management, and
additional information is needed