Treatment of Kawasaki Disease When Initial IVIG Fails to Resolve Fever
In a subset of patients with Kawasaki disease, first-line therapy does not achieve fever resolution. When this occurs, a defined escalation protocol is indicated before further complications can develop.
The initial regimen — IVIG with aspirin — did not reach its primary target: resolution of fever within 36 hours of completing the IVIG infusion. Persistent fever beyond this window defines the indication for escalation to the next treatment step.
Management at this stage centers on a second course of IVIG. Where a repeat IVIG course is not appropriate, glucocorticoid therapy is a recognized alternative.
Full regimen details, dosing, and patient-selection criteria are available in the structured protocol below.
The primary target of this protocol remains resolution of fever.
References
DOI: 10.1002/art.42041
- For patients with acute KD and persistent fevers after initial treatment with IVIG, a second course of IVIG is conditionally recommended over the use of glucocorticoids.
- However, as a conditional recommendation, glucocorticoids are a reasonable alternative (e.g., starting at 2 mg/kg/day and tapering over 15 days or a single dose of 20–30 mg/kg).
- A second course of IVIG in patients who have persistent fever for >36 hours after the first dose is conditionally recommended, as it is the current standard of care.