Antimicrobial therapy using sulfamethoxazole trimethoprim for Kawasaki disease patients unresponsive to intravenous immunoglobulin


Our previous study suggested that the production of superantigens and heat-shock protein 60 by small intestinal bacteria might play a role in Kawasaki disease (KD). We demonstrated that they were all resistant to commonly used antibiotics, except for sulamethoxazole trimethoprim (SMX-TMP). We used SMX-TMP for 7 cases of KD that were unresponsive to intravenous immunoglobulin (IVIG) and studied the antipyretic potency of this treatment. In 6 out of the 7 cases, we demonstrated that antipyretic potency was observed without side effects within 2 days of the initial administration. Antimicrobial therapy using SMX-TMP might represent a novel strategy for cases of KD that are unresponsive to IVIG.

Share and Cite:

Nagata, S. , Yamashiro, Y. , Fujimori, M. , Chiba, Y. , Ohtsuka, Y. and Shimizu, T. (2011) Antimicrobial therapy using sulfamethoxazole trimethoprim for Kawasaki disease patients unresponsive to intravenous immunoglobulin. Open Journal of Pediatrics, 1, 27-29. doi: 10.4236/ojped.2011.13007.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Klassen, P., Rowe P.C. and Gafni, A. (1993) Economic evaluation of intravenous immune globulin therapy for Kawasaki disease. Journal of Pediatrics, 122, 532-542.
[2] Nagata, S., Yamashiro, Y., Ohtsuka, Y., Shimizu, T., Sa-kurai, Y., Misawa, S. and Ito, T. (2009) Heat shock pro-teins and superantigenic properties of bacteria from the gastrointestinal tract of patients with Kawasaki disease. Immunology, 128, 511-520. doi:10.1111/j.1365-2567.2009.03135.x
[3] Kato, H., Koike, S. and Yokoyama, T. (1979) Kawasaki disease: Effect of treatment on coronary artery involve-ment. Pediatrics, 63, 175-179.
[4] McCrindle, B.W., Li, J.S., Minich, L.L., Colan, S.D., Atz, A.M., Takahashi, M., Vetter, V.L., Gersony, W.M., Mit-chell, P.D. and Newburger, J.W. (2007) Coronary artery involvement in children with Kawasaki disease: Risk factors from analysis of serial normalized measurements. Circulation, 116, 174-179. doi:10.1161/CIRCULATIONAHA.107.690875
[5] Rungoe, C., Malchau, E.L., Larsen, L.N. and Schroeder, H. (2010) Infections during induction therapy for children with acute lymphoblastic leukemia. The role of sul-famethoxazole-trimethoprim (SMX-TMP) prophylaxis. Pediatric Blood & Cancer, 55, 304-308. doi:10.1002/pbc.22423
[6] Lindemulder, S. and Albano, E. (2007) Successful inter-mittent prophylaxis with trimethoprim/sulfamethoxazole 2 days per week for Pneumocystis carinii (jiroveci) pneumonia in pediatric oncology patients. Pediatrics, 120, e47-e51. doi:10.1542/peds.2006-1360
[7] Asmar, B.I., Maqbool, S. and Dajani, A.S. (1981) Hema-tologic abnormalities after oral trimetho-prim-sulfamethoxazole therapy in children. American Journal of Diseases of Children, 135, 1100-1103.
[8] Sleeper, L.A., Minich, L.L., McCrindle, B.M., Li, J.S., Mason, W., Colan, S.D., Atz, A.M., Printz, B.F., Baker, A., Vetter, V.L. and Newburger, J.W. (2011) Evaluation of Kawasaki disease risk-scoring systems for intravenous immunoglobulin resistance. Journal of Pediatrics, 158, 831-835. doi:10.1016/j.jpeds.2010.10.031
[9] Shah, I. and Prabhu, S.S. (2009) Response of refractory Kawasaki disease to intravenous methylprednisolone. Annals of Tropical Paediatrics, 29, 51-53. doi:10.1179/146532809X402033
[10] Rowley, A.H. and Shulman, S.T. (2010) Pathogenesis and management of Kawasaki disease. Expert Review of Anti-Infective Therapy, 8, 197-203. doi:10.1586/eri.09.109

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.