Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

all patients

1st line – supportive care

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ACUTE
|
all patients
1st line – 

supportive care

Includes good hydration, antipyretics, and analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs. Aspirin should not be given to children because of the possibility of Reye's syndrome.

Rest remains a frequent recommendation, but its true usefulness in the treatment of IM is unknown. It is also recommended that the patient refrains from strenuous physical activity and contact sports in the initial 3 to 4 weeks (up to 8 weeks in some patients) of illness, due to the potential for splenic rupture.

Primary options

paracetamol: children: 10-15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

OR

ibuprofen: children 5-10 mg/kg orally every 6-8 hours when required, maximum 40 mg/kg/day; adults: 200-400 mg orally every 4-6 hours when required, maximum 2400 mg/day

Plus – corticosteroid

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ACUTE
|
all patients
|
with upper airway obstruction or haemolytic anaemia
Plus – 

corticosteroid

Treatment recommended for ALL patients in selected patient group

Patient should be admitted to hospital.

Corticosteroids may relieve upper airway obstruction by decreasing the size of enlarged tonsils and lymph nodes in the oropharynx.[58] Systemic corticosteroids may improve symptoms of obstruction but intubation, tracheotomy, or tonsillectomy may be required in extreme cases.

Corticosteroids modify the immune response and therefore may be useful in the treatment of haemolytic anaemia as they can hasten resolution.

Primary options

prednisolone: children: 1-2 mg/kg/day orally given in divided doses for 5-7 days; adults: 30-60 mg/day orally given in divided doses for 5-7 days; equivalent intravenous corticosteroid dose may be used for initial days of therapy

Plus – corticosteroids or intravenous immunoglobulin

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ACUTE
|
all patients
|
with thrombocytopaenia
Plus – 

corticosteroids or intravenous immunoglobulin

Treatment recommended for ALL patients in selected patient group

Patient should be admitted to hospital.

Corticosteroids modify the immune response and therefore may be useful in the treatment of immune thrombocytopaenia.

Intravenous immunoglobulin (IVIG) modulates immune system response in patients with IM-associated immune thrombocytopaenia.

IVIG may be considered as an initial treatment choice for patients who have active bleeding.[61] There is no consensus yet as to optimal regimens or combinations of corticosteroid and IVIG. Whether they are given alone or in combination depends on expert opinion and physician preference.[62]

Primary options

prednisolone: children: 1-2 mg/kg/day orally for maximum of 14 days, or 4 mg/kg/day orally for 3-4 days; adults: 0.5 to 2 mg/kg/day orally for 2-4 weeks

OR

methylprednisolone: adults: 30 mg/kg/day intravenously for 7 days

OR

dexamethasone: adults: 40 mg orally once daily for 4 days every 2-4 weeks for 1-4 cycles

OR

normal immunoglobulin human: children: 0.8 to 1 g/kg intravenously as a single dose; adults: 0.4 g/kg/day intravenously for 5 days, or 1 g/kg/day intravenously for 1-2 days

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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