What is the treatment for dengue fever?

Treatment of Dengue Fever

The treatment of dengue fever is primarily supportive, focusing on oral hydration, acetaminophen for fever and pain, daily monitoring until fever resolves, and strict avoidance of NSAIDs and aspirin due to bleeding risk. 1

Clinical Classification and Assessment

Dengue infection presents as a spectrum of illness:

• Dengue fever (mild to moderate disease)
• Dengue hemorrhagic fever (DHF)
• Dengue shock syndrome (DSS)

Warning Signs Requiring Close Monitoring

• Abdominal pain or tenderness
• Persistent vomiting
• Clinical fluid accumulation (pleural effusion, ascites)
• Mucosal bleeding
• Lethargy or restlessness
• Liver enlargement
• Increasing hematocrit with rapid decrease in platelet count 1

Treatment Algorithm

1. Mild to Moderate Disease (Outpatient Management)

• Oral hydration: Encourage adequate fluid intake
• Acetaminophen/paracetamol: For fever and pain control
• Daily follow-up: Until fever resolves
• Strict avoidance: NSAIDs and aspirin (increased bleeding risk)
• Patient education: Monitor for warning signs 1

Outpatient management is appropriate for patients who:

• Have no comorbidities
• Can maintain oral hydration
• Have normal urine output
• Show no bleeding manifestations 1

2. Severe Disease or High-Risk Patients (Inpatient Management)

Hospitalization is recommended for:

• Patients with warning signs
• Pregnant women
• Older adults
• Children
• Patients with comorbidities (diabetes, hypertension, kidney/heart disease, hemoglobinopathies)
• Obesity 1

Inpatient Management Protocol:

• Fluid therapy:
  • Start with crystalloids at 5-10 ml/kg/hour
  • Adjust according to clinical response
  • Monitor for fluid overload
• Laboratory monitoring:
  • Complete blood count (focus on hematocrit and platelets)
  • Liver function tests
• Supportive care:
  • Acetaminophen for fever
  • Close monitoring of vital signs
  • Oxygen supplementation if needed 1

Special Considerations

Severe Thrombocytopenia

• Platelet transfusions have limited role in management unless there is significant bleeding 2
• Monitor for spontaneous bleeding including unusual sites like rectus sheath hematomas 3

Fluid Management in Special Populations

• Children: More susceptible to fluid overload, require closer monitoring
• Pregnant women: Higher risk of complications, need intensive surveillance
• Older adults: More aggressive management due to comorbidities 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

Prevention During Illness

• Prevent mosquito bites during the viremic phase
• Eliminate mosquito breeding sites in the home environment 1

Important Clinical Pearls

• Mortality from dengue can be reduced to less than 0.5% with proper management 1
• Laboratory findings supporting diagnosis include thrombocytopenia (<100,000/mm³), leukopenia, elevated hematocrit, and elevated liver enzymes 1
• The critical phase typically occurs around defervescence (when fever subsides), which is when patients need the closest monitoring 4
• Plasma leakage is the hallmark of severe disease and requires careful fluid management to prevent both hypovolemic shock and fluid overload 1, 4