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The Optimal Dosages of Gammaglobulin and Aspirin in Treating Kawasaki Disease

Journal of the Korean Pediatric Society 1996;39(5):703-711.
Published online May 15, 1996.
The Optimal Dosages of Gammaglobulin and Aspirin in Treating Kawasaki Disease
Seung Baik Han, Jong Woon Choi, Soon Ki Kim, Sei Woo Chung, Jeung Gyu Kim, Byong Kwan Son
Department of Pediatrics, Inha University Hospital, Seongnam, Korea
가와사키병의 치료에서 감마글로불린 및 아스피린의 적정 용량에 관한 연구
한승백, 최종운, 김순기, 정세우, 김정규, 손병관
인하대학교 의과대학 소아과학교실
Abstract
Purpose
: There are some disagreements about the optimal dosages of intravenous gammaglobulin(IVGG) and oral aspirin(ASA) in the treatment of Kawasaki disease. So authors performed a prospective clinical study to evaluate the efficacy of IVGG 1g/kg plus ASA 50mg/kg/day.
Methods
: We treated 29 patients who were admitted to Inha University Hospital from June 1993 through May 1994 with IVGG 1g/kg plus ASA 50mg/kg/d. We compared the outcomes of above patients with those of two other groups of patients, group A and B inauthors’previous study. Group A(20patients) had been treated with IVGG 2g/kg plus ASA 50mg/kg/d and group B(19 patients) with IVGG 2g/kg plus ASA 100mg/kg/d. The outcomes had been similar in group A and B, which was published on this journal in 1995 (vol.38:378-385).
Results
: 1) Twenty five patients(86.2%; group C) were given only one dose of IVGG 1g/kg, and remaining 4 patients(13.8%; group D) were given two doses of IVGG 1g/kg because of persistent high fever. 2) The age and sex distributions, durations of fever before treatment, and durations of ASA therapy in group C were not significantly different from those in group A and B(p>0.05). 3) Laboratory findings on admission in group C were not significantly different from those in group A and B, except that the mean ESR was lower in group C than in group A and B (35.1±19.8 vs 55.5±5.95 & 50.2±11.4mm/hr; p<0.01, respectively). 4) The durations of fever after treatment in group C were not significantly different from those in group A and B (1.32±1.07 vs 2.65±3.28 & 1.74±1.52 days; p>0.05, respectively). 5) In group C, the mean hemoglobin concentration at the 3rd week of illness was higher than in group A (11.1±0.98 vs 10.1±1.24g/dl; p<0.05), the mean platelet countat the 2nd week of illness was lower than in group A (59.4±18.0×104 vs 73.6±19.0×104/μl; p<0.05), and the mean ESRs at the 2nd and 3rd week of illness were lower than in group A (43.3±14.7 vs 54.0±9.16,31.9±19.0 vs 47.7±13.0mm/hr; p<0.05, respectively). Other follow-up laboratory findings in group C were not significantly different from those in group A and B. 6) Echocardiography was done 2 and 4 weeks after onset of illness. Coronary arterial dilation was observed in four(4/25; 16%) and two(2/23; 8.7%) patients respectively in group C, and the proportions were not significantly different from those in group A(40% & 25%) and B(31.6% & 10.5%) (p>0.05, respectively). In follow-up examinations, coronary aneurysm was observed in only one(1/23;4.3%) in group C, which was similar to group A(1/18;5.5%) and B(1/19;5.2%)(p>0.05, respectively). Giant aneurysm was not observed in any patients. 7) Four patients(group D) were given one more dose of IVGG 1g/kg because high fever persisted 48 hours after injection of the first dose of IVGG. Afterthen fever subsided within 1 to 7 days. Echocardiography revealed mild coronary arterial dilation in two patients initially, but follow-up examinations revealed no coronary aneurysm.
Conclusion
: The medium-dose combined regimen with IVGG 1g/kg plus ASA 50mg/kg/d seems to be more cost-effective than the high-dose regimen with IVGG 2g/kg plus ASA 50-100mg/kg/d. If high fever persists 48 hours or more after the first dose of IVGG 1g/kg, it is desirable to give one more dose of IVGG 1g/kg.
Key Words: Kawasaki disease, Intravenous gammaglobulin, Aspirin, Dose


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