Kawasaki disease: Medical therapies

Medical therapies in patients with Kawasaki disease (KD) are administered to reduce the prevalence of coronary aneurysms, reduce systemic inflammation, and prevent coronary thrombosis. All patients with acute KD should be treated with intravenous immunoglobulin (IVIG) 2 g/kg, generally administered over 10-12 hours. Aspirin has never been shown to prevent aneurysms, but is given for its anti-inflammatory and antipyretic effects until the patient has been afebrile for ∼2 days, then lowered to an antiplatelet dose. Adjunctive therapy with a longer course of corticosteroids, together with IVIG and aspirin, may be considered for primary treatment in patients at high risk for development of aneurysms. For patients who have persistent or recrudescent fever after IVIG treatment without other explanation, adjunctive therapies include retreatment with IVIG, a tapering course of corticosteroids, infliximab, cyclosporine, cyclophosphamide, and other immunomodulatory therapies. Antithrombotic therapies are tailored to the risk of thrombosis, and range from aspirin alone for 4-6 weeks in children without aneurysms to a combination of anticoagulation and antiplatelet therapy for those with giant aneurysms.