{ "schema_version": 1, "kind": "condition", "id": "kawasaki-disease", "name": "Kawasaki disease", "category": "acute", "sources": "Kawasaki Disease - StatPearls (NCBI Bookshelf NBK537163) - https://www.ncbi.nlm.nih.gov/books/NBK537163/ · Kawasaki disease - disease-level clinical article (kawasaki-disease-full.txt) · Kawasaki disease - disease-level clinical article (kawasaki-disease-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111)", "review_status": "reviewed", "verified_against": "Kawasaki Disease - StatPearls (NCBI Bookshelf NBK537163) - https://www.ncbi.nlm.nih.gov/books/NBK537163/ · Kawasaki disease - disease-level clinical article (kawasaki-disease-full.txt) · Kawasaki disease - disease-level clinical article (kawasaki-disease-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111)", "verified_date": "2026-08", "treatments": [ { "id": 1044, "generic": "Immunoglobulin", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "Not applicable - Kawasaki disease is a disease of childhood (see the paediatric dose)", "adult_duration": "A single infusion", "dose_source": "Kawasaki Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK537163/", "rationale": "The cited article states that patients should receive high-dose intravenous immunoglobulin at 2 g/kg over 10 to 12 hours together with high-dose aspirin. This is the treatment that prevents the coronary artery aneurysms the disease is feared for, and it is given in hospital - the decision a GP makes is to suspect the diagnosis and send the child in, early enough for it to be given.", "cautions": [ "THIS IS AN ADMISSION, NOT A PRESCRIPTION. It is a hospital infusion. What primary care contributes is suspecting Kawasaki disease early enough for it to be given inside the window in which it protects the coronary arteries.", "GIVE IT WITH ASPIRIN, NOT INSTEAD OF IT. The article names the two together as the treatment.", "THE ARTICLE RAISES A HARM AT THE HIGHER DOSE: concern that 4 g/kg rather than 2 g/kg causes haemolytic anaemia, with children who had complete Kawasaki disease, were resistant to immunoglobulin, and had non-O blood groups most at risk.", "WHAT THE ARTICLE NAMES FOR RESISTANT DISEASE, and it is a specialist decision, not a primary-care one: infliximab 5 mg/kg or cyclophosphamide as alternatives, and extended prednisolone 2 mg/kg/day for 4 to 5 weeks in children at high risk of resistance, from the 2012 RAISE trial - it also records that research results have been inconsistent.", "The Egyptian formulary chapters held here carry no immunoglobulin monograph, so this dose comes from the article alone and the article is named on the row." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "2 g/kg as a single intravenous infusion over 10 to 12 hours. It is written as grams per kilogram rather than as a milligram grid because that is how the article states it and how the infusion is prescribed; the article states no maximum, so none is given here.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "Y-GLOBULIN KGCC I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KORIA GREEN CROSS > EIMC", "price_egp": 37.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "I.V-GLOBULIN 50MG/ML 0.5G VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KORIA GREEN CROSS > EIMC", "price_egp": 360.0, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "INTRAGLOBIN F 50MG/ML (20ML=1G) I.V.INFUSION", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOTEST PHARMA GERMANY > EGYCOPHARM", "price_egp": 600.0, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "INTRAGLOBIN F 50MG/ML (50ML=2.5G) I.V.INFUSION", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOTEST PHARMA GERMANY > EGYCOPHARM", "price_egp": 1450.0, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIGAM-S 5 %W/V (100ML) INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BPL BIO PRODUCTS LAB. U.K. > BIO CARE PHARMA GROUP-EGYPT", "price_egp": 2200.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GAMUNEX-C 10% I.V. VIAL 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRIFOLS THERAPEUTICS LLC > BIOLINX MEDICAL INC.", "price_egp": 6000.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GAMUNEX-C 10% I.V. VIAL 25 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRIFOLS THERAPEUTICS LLC > BIOLINX MEDICAL INC.", "price_egp": 10000.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GAMUNEX-C 10% I.V. VIAL 50 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRIFOLS THERAPEUTICS LLC > BIOLINX MEDICAL INC.", "price_egp": 20000.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "kawasaki-disease" }, { "id": 1045, "generic": "Acetylsalicylic acid", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 75.0, "adult_dose": "Not applicable - Kawasaki disease is a disease of childhood (see the paediatric dose)", "adult_duration": "Two phases: until afebrile, then 6 to 8 weeks", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111)", "rationale": "The cited article names high-dose aspirin alongside immunoglobulin as the treatment, dropped to a low antiplatelet dose once the child has been afebrile for over 48 hours and continued until there is no evidence of cardiac change, about 6 to 8 weeks after onset. The Egyptian formulary names Kawasaki disease among the paediatric indications for acetylsalicylic acid and gives the age-banded schedule used here.", "cautions": [ "THE TWO NAMED SOURCES DO NOT AGREE ON THE HIGH-DOSE PHASE, AND BOTH ARE GIVEN HERE RATHER THAN ONE BEING QUIETLY PREFERRED. The Egyptian formulary's Kawasaki band is 7.5 to 12.5 mg/kg four times a day, which is 30 to 50 mg/kg a day. The article says 80 to 100 mg/kg a day divided every six hours until afebrile for over 48 hours, then 3 to 5 mg/kg. The formulary's figures are printed above because it is the Egyptian formulary and its band is written for this disease by age; the article's higher figure is recorded here so the difference is visible rather than hidden.", "THIS IS THE ONE DISEASE WHERE A CHILD IS GIVEN ASPIRIN ON PURPOSE. The formulary's general rule still stands beside it: do not use aspirin under 18 in a child who has or is recovering from chickenpox or influenza-like illness, because of Reye's syndrome, and give it under 16 only on a doctor's advice.", "IT IS STARTED IN HOSPITAL. Both phases run alongside the immunoglobulin infusion and the echocardiography that decides when it stops.", "Do not give in hypersensitivity to NSAIDs, in asthma with rhinitis and nasal polyps, or in active peptic ulceration." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Formulary schedule, oral, in two phases. Neonate: 8 mg/kg four times a day for 2 weeks or until afebrile, then 5 mg/kg once daily for 6 to 8 weeks. Child 1 month to 11 years: 7.5 to 12.5 mg/kg four times a day for 2 weeks or until afebrile, then 2 to 5 mg/kg once daily for 6 to 8 weeks. In both, if there is no evidence of coronary lesions after 8 weeks, stop or seek expert advice.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "Neonate", "age_min_months": 0, "age_max_months": 0, "dose_text": "8 mg/kg four times a day for 2 weeks or until afebrile, then 5 mg/kg once daily for 6 to 8 weeks. If there is no evidence of coronary lesions after 8 weeks, stop or seek expert advice." }, { "label": "1 month to 11 years", "age_min_months": 1, "age_max_months": 143, "dose_text": "7.5 to 12.5 mg/kg four times a day for 2 weeks or until afebrile, then 2 to 5 mg/kg once daily for 6 to 8 weeks. If there is no evidence of coronary lesions after 8 weeks, stop or seek expert advice." } ], "peds_doses": null, "brands": [ { "trade_name": "AGGREX 75MG 60 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 33.0, "pack_count": 60, "unit_price": 0.55, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ASPOCID 75MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 22.0, "pack_count": 20, "unit_price": 1.1, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ASPOCID 75MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 33.0, "pack_count": 30, "unit_price": 1.1, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ASPIRIN-CHEMIPHARM 75 MG 30 CHEW.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIVO 75 MG 30 CHEW. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 21.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ASPOCID PAEDIATRIC 75MG 30 CHEW. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 35.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EZACARD 75 MG 30 E.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 51.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "kawasaki-disease" }, { "id": 1046, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Kawasaki Disease - StatPearls (NCBI Bookshelf NBK537163) - https://www.ncbi.nlm.nih.gov/books/NBK537163/", "rationale": "Kawasaki disease is treated in hospital with intravenous immunoglobulin and aspirin, and the whole primary-care task is to recognise it early enough for that to work. Both are set out above so the referral is an informed one - neither is started in a clinic, and nothing given in a clinic alters the coronary risk.", "cautions": [ "THE TRIGGER IS FIVE DAYS OF FEVER - the article's mnemonic opens on fever lasting more than 5 days. The fever is the most consistent feature, it barely answers antipyretics, and it usually sits above 38.5 degrees Celsius. A child whose fever shrugs off paracetamol for five days is the child to think of Kawasaki in.", "THE FIVE OTHER FEATURES - conjunctivitis with no exudate. Rash. Hands or feet swollen or red, then peeling, with changes in the nails. Adenopathy, often on one side, a cervical node bigger than 1.5 cm. And the mouth: red mucosa, lips fissured or crusted, or a strawberry tongue.", "ASK ABOUT FEATURES THAT HAVE ALREADY GONE - these features tend to arrive one after another rather than all together, and that sequence is what points to Kawasaki rather than the other diagnoses on the list. The red eyes may have settled by the day the child reaches the clinic.", "AN INFANT CAN HAVE KAWASAKI WITH ALMOST NOTHING ELSE - consider incomplete Kawasaki disease in a child with fever of five days or more and only two or three major criteria present; it is commoner in the younger infants and in the older children. So where an infant under 6 months has had a fever running over 7 days, get an echocardiogram to rule Kawasaki out.", "WHY THE DELAY COSTS THE HEART - IVIG ideally goes in within 7-10 days of the fever starting, to head off cardiac complications; given in that window it brings coronary artery aneurysm down from 25% to 3-5%. Referral inside that window is the entire clinical value of recognising Kawasaki disease.", "AND THE LONGER THE FEVER RUNS, THE WORSE THE ODDS - top of the article's list of risks for coronary artery aneurysm is fever lasting more than 8 days, which it calls the most important risk factor of all. Next on that list: fever coming back after the child has been afebrile for 48 hours.", "TREATMENT IS INPATIENT AND INTRAVENOUS - high-dose IVIG, 2 g/kg run over 10-12 hours, and aspirin (ASA) in high dose too: 80 to 100 mg/kg/day, divided six-hourly, carried on until the child has been afebrile more than 48 hours. Those are hospital numbers, printed so a family can be told what is coming, and not a primary-care prescription.", "DO NOT START ASPIRIN IN A FEBRILE CHILD IN THE CLINIC - the same article warns that a child on ASA who catches influenza or varicella runs a higher risk of Reye syndrome. It adds a second worry: in the acute phase, low albumin, slow gastric transit and high renal clearance mean toxic effects can appear at lower doses than expected.", "WHAT IS AT STAKE IF IT IS MISSED - untreated, about 15-25% of children go on to develop coronary artery aneurysms. And every death from Kawasaki is essentially a cardiac one, typically falling 15-45 days after the fever began.", "AGE SHIFTS THE PROGNOSIS BOTH WAYS - children diagnosed between 6 months and 9 years do better than the younger and the older, perhaps because the classic picture brings them in sooner.", "VACCINES AFTER TREATMENT NEED A GAP - IVIG can stop a vaccine taking, so a routine vaccine such as MMR may have to be put back." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "kawasaki-disease" } ] }