Treatments for Kawasaki Disease
Investigations
Blood tests
Other optional tests
TREATMENT FOR KD
Threapy
ASA+IVIG or ASA+INFLIXIMAB
IVMP 30MG/KG BWTX3HRS X3DAYS
ULINASTATIN
DOXICYLIN can mitigate TNF-a- induced MMP-9-mediated coronary elastin breakdown and improve coronary outcome
Antioxidants (HIGH DOSE VITAMINS -ACE)
HMG COA REDUCTASE(SIMAVASTATIN);CA remodeling and inhibition of inflammation
Therapy For IVIG Resistant Group
SECOND DOSE OF IVIG+IVMP
OR INFLIXIMAB 5mg/kg/Bwt/dose infusion + IVMP OR
ETNARCEPT 0.8mg/kg/Bwt/sc/wk+IVMP(ETACEPT CIPLA)
OR ULINASATIN 20000-30000 UNIT/KG Bwt OD IV X 3DAYS + IVMP
CYCLOSPORIN-A-Doses 3 - 8mg/Kg/Day PO X 5-6 days depends on a febrile period (serum level 400-500mg/ml)
METHOTREXATE
PLASMA EXCHANGE may be the final choice for Refractory KD
See Guidelines; http://www.pediatrics.org/cgi/content/full/114/6/1708
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CORONARY ARTERY NOMOGRAM
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Coronary artery Echocardiographic evaluation
- The initial Echocardiographic evaluation will be obtained as soon as the diagnosis of KD is made.
- The normal coronary artery diameters correlate with BSA. In those with BSA < 0.5 m2, £ 2.5mm; BSA 0.5- 1.0 m2, 2.5-3.0 mm.
- In children < 5 years of age, a proximal RCA, LMC, LCX and LAD exceeding 3mm and 5mm above 5 years considered dilated. (Japanese Ministry of Health Criteria), Irregularity of lumen also to be evaluated.
Mean and prediction limits for 2 and 3SDs for size of LAD (A), proximal RCA (B), and LMCA(C) according to BSA for children ,18years old. LMCA z scores should not be based on dimension at orifice and immediate vicinity; enlargement of LMCA secondary to KA usually is associated with ectasia od LAD, LCX or both. |
Proposed Dosage Schedule
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Table 1: Proposed dosage schedule of antioxidants for the prevention of CAD in KD along with IVIG and Aspirin, is now under clinical trial
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AGE VIT A VIT E VIT C
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ROUTES AND Once daily Once daily Two divided
FREQUENCY x 4 Days x 14 Days doses x 14
Oral Oral days oral
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>6MONTHS 25,000 IU 100 IU 500MG
6MO TO 1-YEAR 50,000 IU 100IU 500MG
1 TO 2 –YEAR 50,000 IU 200IU 500MG
ABOVE 2 YEAR 50,000 IU 400IU 1000MG
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