Management

Early recognition and treatment of Kawasaki disease with aspirin and intravenous immunoglobulin (IVIG) has been shown in meta-analyses to unequivocally reduce the occurrence of coronary artery aneurysms.

IVIG

IVIG is most effective at reducing coronary artery aneurysms when administered within ten days of the onset of fever. The current recommendation is for a single dose of IVIG at 2g/kg over 12 hours.  A single dose vs split dosing has been investigated; a meta-analysis concluded that a single dose has the greatest therapeutic effect in the prevention of coronary artery aneurysms^3,15.

Aspirin

Aspirin reduces the chance of blood clot formation. Aspirin at a dose of 3050 mg/kg/day in four divided doses is recommended during the acute phase of the illness.  The dose should be reduced to 35 mg/kg for 6-8 weeks once fever and inflammation have subsided.  Higher initial doses have been trialled, however, these doses were less well tolerated and did not reduce the incidence of coronary artery aneurysm^3,15.

It is considered the benefits of aspirin in the management of Kawasaki disease outweigh the risks of Reyes syndrome, which usually contraindicates the use of aspirin in children.

Learning Bite

Delayed treatment is related to poorer outcomes.