The most effective medical therapy in ameliorating the symptoms of Kawasaki's disease and preventing the development of giant coronary artery aneurysms is administration of:

D. Gamma globulin.

DISCUSSION: Kawasaki's disease is a multisystemic disorder of unknown cause and is the leading cause of acquired heart disease in children in both Japan and the United States. Although many clinical aspects of Kawasaki's disease suggest an infectious agent, the search for a single agent has been unsuccessful; neither antibacterials nor antivirals have a role in the therapy of Kawasaki's disease. The goal of initial therapy of Kawasaki's disease is the reduction of inflammation, including coronary and myocardial inflammation. After the diagnosis of Kawasaki's disease is secured, patients are treated with intravenous gamma globulin and large doses of aspirin. Gamma globulin, 2 gm. per kg., is administered as a single infusion over 12 hours. Treatment with intravenous immune globulin has been shown to decrease the duration of fever, to decrease the prevalence of cardiovascular complications, and to prevent the progression to giant coronary aneurysms. High-dose aspirin therapy contributes to the resolution of the acute manifestations of Kawasaki's disease. When Kawasaki's disease is diagnosed, children are given a regimen of aspirin, 100 mg. per kg. per day, which is continued until defervescence. Thereafter, they are maintained on small doses of aspirin, 3 to 5 mg. per kg. per day, for 8 weeks. The goal of aspirin therapy is amelioration of symptoms and prevention of the thrombotic and embolic complications of Kawasaki's disease. Aspirin does not decrease the risk of the development of coronary aneurysms. There is no role for glucocorticoids in the treatment of Kawasaki's disease.