Treatment for Dengue Fever
The treatment for dengue is primarily supportive care, focusing on adequate hydration, fever control with acetaminophen/paracetamol, and close monitoring for warning signs of severe disease. 1
Assessment and Classification
Dengue is classified into three categories according to the World Health Organization:
- Dengue without warning signs
- Dengue with warning signs
- Severe dengue
Warning Signs to Monitor
- Abdominal pain or tenderness
- Persistent vomiting
- Clinical fluid accumulation
- Mucosal bleeding
- Lethargy or restlessness
- Liver enlargement
- Increasing hematocrit with rapid decrease in platelet count 1
Management Protocol
Outpatient Management
Patients can be managed as outpatients if they:
- Have no comorbidities
- Can maintain oral hydration
- Have normal urine output
- Show no bleeding manifestations 1
Outpatient treatment includes:
- Oral hydration (encourage fluid intake)
- Acetaminophen/paracetamol for fever and pain
- AVOID NSAIDs, aspirin, and steroids due to bleeding risk
- Daily follow-up until fever resolves 1
Indications for Hospitalization
- Presence of warning signs
- High-risk factors: pregnancy, advanced age, obesity, diabetes, hypertension, kidney or heart disease, hemoglobinopathies
- Inability to maintain oral hydration
- Bleeding manifestations 1
Hospital Management
- Intravenous fluid therapy with crystalloids at 5-10 ml/kg/hour
- Adjust according to clinical response
- Goal: diuresis >0.5 ml/kg/hour in adults and >1 ml/kg/hour in children
- Continuous monitoring of:
- Vital signs
- Fluid balance
- Laboratory parameters (CBC, hematocrit, platelet count)
- Signs of capillary leak 1
Laboratory Monitoring
Essential tests include:
- Complete blood count with hematocrit and platelet count
- Liver function tests
- Renal function tests
- Coagulation profile (if bleeding manifestations are present) 1
Special Populations Requiring Closer Monitoring
- Pregnant women: Higher risk of complications, require intensive surveillance
- Children: More susceptible to fluid overload, require careful fluid management
- Older adults: Higher risk of severe dengue due to comorbidities
- Patients with secondary infections: At increased risk for severe manifestations 1
Discharge Criteria
Patients can be discharged when:
- No fever for 48 hours without antipyretics
- Improving clinical status
- Increasing platelet count
- Stable hematocrit
- No respiratory distress
- Good urine output 1
Important Clinical Pearls
There is no specific antiviral treatment for dengue - management is entirely supportive 2
Avoid NSAIDs and aspirin as they may increase bleeding risk
Secondary dengue infections (previous exposure to a different serotype) carry a higher risk of severe disease and require closer monitoring 1
With proper management, mortality from dengue can be reduced to less than 0.5% even in hospitalized patients 1
Prevention is crucial - advise patients to prevent mosquito bites and eliminate breeding sites 1
Prevention
- Use of mosquito repellents
- Wearing appropriate clothing
- Using mosquito nets
- Eliminating mosquito breeding sites
- Tetravalent vaccine (Dengvaxia) is available in some countries but recommended only for those with confirmed previous dengue infection 1
The key to successful management of dengue is early recognition, appropriate fluid management, and vigilant monitoring for progression to severe disease. With proper supportive care, most patients recover completely without long-term complications.