What is the recommended treatment for dengue fever?

Recommended Treatment for Dengue Fever

The recommended treatment for dengue fever is primarily supportive care, focusing on oral hydration, acetaminophen/paracetamol for fever and pain management, daily follow-up until fever resolves, and strict avoidance of NSAIDs and aspirin due to bleeding risk. 1

Initial Management (Outpatient)

For uncomplicated dengue without warning signs:

• Oral rehydration: Encourage adequate fluid intake to prevent dehydration
• Fever control: Use acetaminophen/paracetamol only (maximum 4g/day in adults)
• Avoid NSAIDs and aspirin: These medications increase bleeding risk
• Daily monitoring: Follow up until fever resolves to detect early warning signs

Patients can be managed as outpatients if they:

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

Warning Signs Requiring Closer Monitoring

Monitor closely for:

• 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

Indications for Hospitalization

Hospitalize patients with:

• Any warning signs as listed above
• High-risk factors: pregnancy, advanced age, obesity, diabetes, hypertension, kidney or heart disease, hemoglobinopathies 1

Inpatient Management

Fluid Management (Critical Component)

• Initial fluid therapy:

  • Start with crystalloids (0.9% normal saline or Ringer's lactate) at 5-10 ml/kg/hour
  • Adjust rate according to clinical response 1, 2

• For dengue shock syndrome (DSS):

  • Most patients can be successfully treated with isotonic crystalloid solutions
  • If unresponsive to adequate crystalloid resuscitation, consider switching to colloids 2, 3
  • For severe cases with fluid restrictions (e.g., pulmonary edema), consider adding vasopressors like norepinephrine 2

Monitoring During Treatment

• Vital signs: Monitor every 1-4 hours depending on severity
• Fluid input/output: Strict monitoring to avoid both dehydration and fluid overload
• Hematocrit: Serial measurements to assess hemoconcentration
• Platelet count: Monitor for thrombocytopenia
• Clinical signs of plasma leakage 1

Special Populations Requiring Modified Approaches

• Children: More susceptible to fluid overload; require closer monitoring and careful fluid management 1
• Pregnant women: Higher risk of complications; require more intensive surveillance 1
• Older adults: Higher risk of severe dengue due to comorbidities; may require more aggressive management 1

Discharge Criteria

Patients can be discharged when they have:

• No fever for 48 hours without antipyretics
• Improving clinical status
• Increasing platelet count
• Stable hematocrit
• No respiratory distress
• Good urine output 1

Important Caveats

• No role for corticosteroids: Evidence for corticosteroid use in dengue is inconclusive with low to very low quality evidence, and they are not recommended in standard treatment 4

• No prophylactic platelet transfusions: These are not recommended as routine management 5

• Careful fluid management during recovery phase: After stabilizing hemodynamics and clinical improvement, reduce and discontinue fluids gradually to avoid congestion and other complications 2

• No specific antiviral therapy: Despite ongoing research, there are currently no approved antiviral medications specifically for dengue 5

• Mortality reduction: Following established protocols can reduce mortality to less than 0.5% even in hospitalized patients 1