All issues > Volume 39(5); 1996

Original Article

J Korean Pediatr Soc. 1996;39(5):703-711. Published online May 15, 1996.

The Optimal Dosages of Gammaglobulin and Aspirin in Treating Kawasaki Disease

Seung Baik SB Han¹, Jong Woon JW Choi¹, Soon Ki SK Kim¹, Sei Woo SW Chung¹, Jeung Gyu JG Kim¹, Byong Kwan BK Son¹

¹Department of Pediatrics, Inha University Hospital, Seongnam, Korea

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.

Keywords :Kawasaki disease, Intravenous gammaglobulin, Aspirin, Dose