What is the treatment for dengue?

Dengue Treatment

Dengue treatment is primarily supportive with no specific antiviral therapy currently approved, focusing on careful fluid management, symptom control with acetaminophen only, and close monitoring for progression to shock during the critical phase (days 3-7 of illness). 1

Symptomatic Management

• Use acetaminophen (paracetamol) exclusively for fever and pain control. 1
• Strictly avoid aspirin and all NSAIDs due to increased bleeding risk from thrombocytopenia and platelet dysfunction. 1
• Encourage resumption of age-appropriate diet as soon as appetite returns. 1

Fluid Management Strategy

For Patients WITHOUT Shock

• Oral rehydration is the cornerstone of treatment for uncomplicated dengue. 1
• Target approximately 2,500-3,000 mL daily fluid intake (roughly 5 or more glasses throughout the day), using water, oral rehydration solutions, cereal-based gruels, soup, or rice water. 1
• Avoid routine bolus intravenous fluids in patients with severe febrile illness who are NOT in shock, as this increases risk of fluid overload and respiratory complications without improving outcomes. 1

For Patients WITH Dengue Shock Syndrome

• Administer 20 mL/kg of isotonic crystalloid (Ringer's lactate or 0.9% normal saline) as a rapid bolus over 5-10 minutes. 1
• Reassess after each bolus for signs of improvement: reduced tachycardia, improved capillary refill, warming of extremities, improved mental status, and adequate urine output. 1
• If shock persists, repeat crystalloid boluses up to a total of 40-60 mL/kg in the first hour before escalating therapy. 1
• For refractory shock after adequate crystalloid resuscitation, switch to colloid solutions (dextran, gelafundin, or albumin), which achieve faster resolution of shock (RR 1.09,95% CI 1.00-1.19) and require less total volume (mean 31.7 mL/kg versus 40.63 mL/kg for crystalloids). 1

Vasopressor Support for Refractory Shock

• For cold shock with hypotension: titrate epinephrine as first-line vasopressor. 1
• For warm shock with hypotension: titrate norepinephrine as first-line vasopressor. 1
• Begin peripheral inotropic support immediately if central venous access is not readily available, as delays in vasopressor therapy significantly increase mortality. 1
• Target mean arterial pressure appropriate for age and maintain ScvO2 >70%. 1

Monitoring Parameters

Daily Laboratory Monitoring

• Perform daily complete blood count to track platelet counts and hematocrit levels, particularly during the critical phase. 1
• Watch for warning signs of progression to severe disease: high hematocrit with rapidly falling platelet count, severe abdominal pain, persistent vomiting, lethargy or restlessness, and mucosal bleeding. 1

Clinical Perfusion Indicators

• Monitor for adequate tissue perfusion: normal capillary refill time (<2 seconds), absence of skin mottling, warm and dry extremities, well-felt peripheral pulses, return to baseline mental status, and adequate urine output (>0.5 mL/kg/hr). 1
• Blood pressure alone is not a reliable endpoint in children, as hypotension is a late sign of shock. 1

Signs of Fluid Overload

• Stop fluid resuscitation immediately if hepatomegaly, pulmonary rales, or respiratory distress develop. 1
• Switch from fluids to inotropic support when fluid overload appears. 1

Management of Bleeding Complications

• Blood transfusion may be necessary in cases of significant bleeding, though this is reserved for clinically significant hemorrhage rather than thrombocytopenia alone. 1

Critical Pitfalls to Avoid

• Do not delay fluid resuscitation in established dengue shock syndrome, as cardiovascular collapse may rapidly follow once hypotension occurs. 1
• Do not use restrictive fluid strategies in dengue shock syndrome—moderate-quality evidence shows no survival benefit and may worsen outcomes, with three RCTs demonstrating near 100% survival with aggressive fluid management. 1
• Do not fail to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock. 1
• Do not continue aggressive fluid resuscitation once signs of fluid overload appear, particularly during the recovery phase when reabsorption of extravasated fluid occurs. 1
• Do not administer excessive fluid boluses in patients without shock, as this leads to pulmonary edema and respiratory complications. 1