From the Guidelines
The recommended treatment for dengue fever is primarily supportive care, focusing on managing symptoms and preventing complications, with an emphasis on fluid replacement and monitoring for severe symptoms. Treatment should include rest, oral rehydration solutions or intravenous fluids if necessary, and acetaminophen (paracetamol) for fever and pain at a dose of 500-1000mg every 6 hours, not exceeding 4000mg daily for adults 1. It is crucial to avoid NSAIDs like ibuprofen and aspirin due to their potential to increase bleeding risk. Patients should be monitored closely for warning signs of severe dengue, such as severe abdominal pain, persistent vomiting, bleeding gums, rapid breathing, fatigue, restlessness, or blood in vomit or stool, which require immediate medical attention 1.
For patients with severe dengue, particularly those with shock syndrome, the use of crystalloids and/or colloids for fluid resuscitation is recommended, with colloids potentially offering benefits in children with severe Dengue shock syndrome 1. In cases where fluid resuscitation is insufficient to restore tissue perfusion, the use of dopamine or epinephrine (adrenaline) should be considered, with careful monitoring of arterial blood pressure and heart rate 1. Additionally, intravenous hydrocortisone or prednisolone may be administered to adult patients requiring escalating dosages of epinephrine or dopamine, and considered in children with severe shock 1.
Key aspects of care include:
- Fluid replacement to maintain hydration
- Monitoring for signs of severe dengue
- Use of acetaminophen for fever and pain management
- Avoidance of NSAIDs
- Potential use of dopamine or epinephrine in cases of severe shock
- Consideration of intravenous hydrocortisone or prednisolone in specific scenarios
Given the self-limiting nature of dengue fever, the primary goal of treatment is to support the body's immune system in fighting the infection while preventing complications, making supportive care the cornerstone of management 2, 1.
From the Research
Recommended Treatment for Dengue Fever
The recommended treatment for dengue fever is primarily supportive, focusing on managing symptoms and preventing complications. Key aspects of treatment include:
- Fluid management: Judicious fluid resuscitation during the critical phase of dengue is crucial, with crystalloids as the initial fluid of choice 3.
- Symptomatic treatment: Supportive care is the mainstay of management, as there is currently no effective anti-viral agent available for the treatment of dengue 4.
- Monitoring for complications: Organ involvement in severe dengue should be carefully looked for and managed, and secondary hemophagocytic lymphohistiocytosis should be recognized and treated with steroids or intravenous immunoglobulin if necessary 3.
Current Limitations and Future Directions
Despite ongoing research, there are currently no effective vaccines or licensed antiviral treatments available for dengue fever. However, various approaches are being explored, including:
- Vaccine development: Efforts are being made to produce a vaccine that can target all four serotypes of the virus 5.
- Antiviral agents: Research is ongoing to develop antiviral agents that can target viral proteins vital for the replication process 5.
- Monoclonal antibodies: These are being researched as a potential way to equip the host defense mechanism against the dengue virus 5.
Supportive Care
Supportive care is the primary approach to managing dengue fever, and includes: