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Multiple intravenous antibiotics usage is associated with intravenous immunoglobulin resistance in Kawasaki disease

Zon-Min Lee1, Chiao-Lun Chu2, Chi-Hsiang Chu3

  • 1Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Taiwan.

Pediatrics and Neonatology
|October 30, 2021
PubMed

Insights

Antibiotic use in children with Kawasaki disease (KD) may increase resistance to immunoglobulin (IVIG) treatment. Multiple antibiotic use correlated with higher IVIG resistance rates, suggesting cautious prescription for suspected infections.

Area of Science:

  • Pediatrics
  • Rheumatology
  • Infectious Diseases

Background:

  • Kawasaki disease (KD) is a critical vasculitis affecting young children.
  • Antibiotics are frequently given to KD patients before diagnosis due to fever and inflammation.
  • The impact of antibiotic exposure on KD treatment outcomes requires investigation.

Purpose of the Study:

  • To determine how antibiotic usage affects the treatment outcomes of Kawasaki disease.
  • To analyze the relationship between antibiotic administration and immunoglobulin (IVIG) resistance in KD patients.

Main Methods:

  • Retrospective chart review of 280 children diagnosed with KD between 2005 and 2017.
  • Exclusion of KD patients receiving initial IVIG treatment more than 10 days after symptom onset.
  • Comparison of IVIG resistance rates among non-antibiotic users, single-antibiotic users, and multiple-antibiotic users.

Main Results:

  • Children receiving multiple antibiotics showed significantly higher IVIG resistance rates (21.6%) compared to non-users (5.6%) and single-drug users (8.9%).
  • Increased C-reactive protein (CRP) levels correlated with a higher likelihood of IVIG resistance (p < 0.001).
  • White blood cell (WBC) count did not show a significant association with IVIG resistance (p = 0.466).

Conclusions:

  • The use of multiple intravenous antibiotics in Kawasaki disease patients is associated with increased IVIG resistance.
  • Elevated CRP levels are a predictor of IVIG resistance in KD.
  • Physicians should exercise caution when prescribing multiple antibiotics for presumed infections in KD patients to optimize treatment outcomes.
Abstract

Keywords:
IVIG resistanceKawasaki diseaseantibiotics

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