Kawasaki Disease: Treatment

Initial Therapy
Agent	Description	Dose	Additional Information
IVIG	Pooled polyclonal immunoglobulin	2 gm/kg IV, given over 8–12 h; consider slower infusion in KD shock or myocardial dysfunction Utilize lean body mass for dosing in patients with obesity	Risk of hemolytic anemia in patients with obesity unless using lean body mass Aseptic meningitis is associated with higher doses (> 1gm/kg and/or rapid infusions) Risk of infusion reaction (pre-treat with acetaminophen and diphenhydramine, and have epinephrine available when ordering IVIG) If infliximab will also be given, see below for order of therapies
Aspirin	Acetylsalicylic acid	Moderate dose: 7.5-12.5 mg/kg/dose PO q6h Low dose: 3-5 mg/kg PO per day at time of discharge	Do not administer with NSAIDs as efficacy is reduced For patients in whom aspirin cannot be used, for example in glucose-6 phosphate dehydrogenase deficiency or acute infection with influenza, an alternative antiplatelet class of medications can be used
Possible Additional Therapies
Agent	Description	Dose	Additional Information
Corticosteroids	Prednisone or Prednisolone or Methylprednisolone	As directed by Rheumatology	Provide famotidine to prevent gastric ulcers
Infliximab	Monoclonal antibody against TNFα	10 mg/kg IV given over 2 h	If echocardiogram results are available before starting IVIG, -AND- there is a plan to administer both IVIG and infliximab: Give the infliximab FIRST as that will decrease the risk of IVIG infusion reactions
Anakinra	Recombinant interleukin-1b receptor antagonist	As directed by Rheumatology	--
Second dose of IVIG	Pooled polyclonal immunoglobulin	2 g/kg IV given over 8–12 h	Increased risk of hemolytic anemia Increased risk of aseptic meningitis
Clopidogrel	Antiplatelet	1 mg/kg PO per day (max dose 75 mg)	Aspirin should be decreased to low dose (3-5 mg/kg PO per day) when adding clopidogrel
Rivaroxaban or enoxaprin	Anticoagulation	Refer to Rivaroxaban algorithm for dosing Anticoagulation Therapies & VTE Risk Assessment Clinical Pathway: Rivaroxaban algorithm	Discuss with cardiology regarding dual antiplatelet therapy with anticoagulation

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Kawasaki Disease: Treatment

Initial Therapy

Possible Additional Therapies

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