Kawasaki Disease or Incomplete Kawasaki Disease — Infliximab Therapy — Clinical Pathway: Emergency, Inpatient

Kawasaki Disease or Incomplete Kawasaki Disease Clinical Pathway — Emergency Department and Inpatient

Infliximab Therapy

Dose
  • 10 mg/kg/dose as a single infusion (rounded to the nearest 50 mg increment)
  • For treatment of Kawasaki disease, patients do not need to undergo tuberculosis screening prior to administration
Treatment Considerations
  • Vital signs should be taken prior to initiation of infusion, every 30 minutes throughout infusion, and 30 minutes after infusion is completed. If no adverse events during infusion, the patient does not need vital signs 30 min post-completion.
  • Rapid infusion titration may be selected in all patients for initiation of Infliximab. Standard infusion should be considered in patients with prior reactions, decreased cardiac output, or sensitivity to fluid overload.
  • Rapid infusion titration:
    Infuse over at least 1 hour
    • Doses < 100 mg:
      • Start rate at 40 ml/hr x 15 min
      • Infusion rate may be increased to the max rate of 120 ml/hr
    • Doses 100 mg to 1,000 mg:
      • Start rate at 100 ml/hr x 15 min
      • Infusion rate may be increased to max rate of 300 ml/hr
    • Doses > 1,000 mg:
      • Start rate at 100 ml/hr x 15 min
      • Infusion rate may be increased to 300 ml/h x 15 min, then increase infusion to the max rate of 500 ml/hr
    • After completion of infusion, tubing should be flushed with NS
  • Standard infusion titration:
    Infuse over at least 2 hours
    • Doses < 100 mg:
      • Start rate at 5 ml/hr x 15 min
      • Infusion rate may be doubled every 15 min as tolerated; max rate 80 ml/hr
    • Doses ≥ 100 mg:
      • Start rate at 10 ml/hr x 15 min
      • Infusion rate may be doubled every 15 min as tolerated; max rate 250 ml/hr
    • After completion of infusion, tubing should be flushed with NS
Pre-treatment Considerations
  • Pre-treatment is generally not necessary for first time use or if there is no prior reaction. In the setting of prior infusion reactions may pre-treat with diphenhydramine, acetaminophen and/or methylprednisolone/prednisolone.
  • PRN anaphylaxis medication should be ordered with Infliximab.
Reactions
  • Hypersensitivity or infusion reactions (≤ 20%, severe reactions < 1%):
    • Acute infusion reactions may occur within 2 hours (itching, hives, difficulty breathing, chest pain, low or high blood pressure, chills, fever)
    • Medication and equipment for management of hypersensitivity reaction should be available for immediate use
    • Interruptions and/or reinstitution at a slower rate may be required
  • Infections:
    • Patients on chronic therapy are at increased risk for serious infections such as TB, invasive fungal, bacterial and viral illnesses. Risks are thought to be low for single-dose use.
  • Common reactions:
    • Headache
    • Abdominal pain
    • Coughing
Special Considerations
  • Contraindicated if any of the following:
    • Known hypersensitivity to murine proteins
    • Serious or active infections
    • Acute tuberculosis
    • Moderate to severe congestive heart failure