Salicylate treatment in Kawasaki disease: high dose or low dose?

Salicylate is the basic therapy for Kawasaki disease, however its optimal dose is controversial. We investigated the therapeutic efficacy of high dose (100 mg/kg per day, n=30) versus low dose (30 mg/kg per day, n=30) salicylate. Duration of fever, SGPT, serum salicylate, plasma thromboxane B₂ (TxB₂) and 6-ketoprostaglandin F1α (PGF1α) levels were compared before enrollment and on days 4,7 and 14 of treatment. In the high dose group, duration of fever was significantly shorter than that of the low dose group (3.2±0.3 versus 5.4±0.8 days, P<0.05), however, SGPT levels were significantly elevated (157±34 versus 48±11 IU/l, P<0.05). No differences in the incidence of coronary artery lesions were observed (5/30 versus 7/30). Plasma TxB₂ production was completely blocked in both groups, and plasma 6-keto-PGF1α levels in the high dose group on day 14 was lower than that in the low dose group (39±8 versus 159±65 pg/ml, P<0.05). SGPT and plasma 6-keto-PGF1α correlated with serum salicylate concentration. These data suggest that high dose salicylate therapy may be disadvantageous as anti-thrombotic therapy, and supports the notion that low dose therapy is safe in the acute stage of Kawasaki disease.