Preventing Coronary Involvement in Kawasaki Disease

To the Editor.— We congratulate Dr Koren and associates for their informative report on the efficacy of high-dose salicylates in reducing coronary involvement in Kawasaki disease (KD). 1 Failure of the Japanese to document this concept earlier is clearly related to dosage; ie, 30 mg/ kg/day of salicylate is at best analgesic and in no way anti-inflammatory. Like Koren and co-workers, we have also found that high-dose salicylate therapy not only abolishes the high fever of KD but also lowers the incidence of subsequent cardiac involvement. 2-4 In fact, of 35 patients with KD followed up since January 1978, none have developed permanent cardiac sequelae. All have received anti-inflammatory quantities of aspirin, achieving serum salicylate levels between 12 and 25 mg/dL. Most children received upward of 100 mg/ kg/day (range, 80 to 150 mg/kg/day) in four divided doses until they were well (afebrile) and the erythrocyte sedimentation rate returned to