What is the treatment for dengue fever?

Treatment of Dengue Fever

Dengue fever treatment is primarily supportive, focusing on adequate hydration, acetaminophen for pain and fever control, and close monitoring for progression to severe disease—there is no specific antiviral therapy available. 1, 2

Pain and Fever Management

• Acetaminophen (paracetamol) is the only recommended analgesic, dosed at 10-15 mg/kg every 4-6 hours, not exceeding 4 grams daily in adults 3
• Aspirin and NSAIDs are absolutely contraindicated due to increased bleeding risk from thrombocytopenia and platelet dysfunction 1, 3, 2
• Monitor liver function tests when using acetaminophen, particularly in patients with hepatic involvement 3

Fluid Management Strategy

For Patients Without Shock (Dengue Fever)

• Encourage oral hydration with a target of >2,500 mL daily using water, oral rehydration solutions, cereal-based gruels, soup, or rice water 1, 2
• Avoid soft drinks due to high osmolality 2
• Oral rehydration solutions should be used for moderate dehydration 1

For Dengue Shock Syndrome

• Administer 20 mL/kg isotonic crystalloid (Ringer's lactate or 0.9% normal saline) as a rapid bolus over 5-10 minutes 1, 2
• Reassess immediately after each bolus for signs of improvement (decreased tachycardia, improved capillary refill, warming of extremities) 2
• Repeat crystalloid boluses up to 40-60 mL/kg in the first hour if shock persists 2
• For severe shock with pulse pressure <10 mmHg or refractory shock, escalate to colloid solutions (dextran, gelafundin, or albumin) 1, 2
• Colloids 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) 2

Critical Monitoring Parameters

• Perform daily complete blood counts to track platelet counts and hematocrit levels 1, 2
• Watch for warning signs of severe dengue: persistent vomiting, severe abdominal pain, lethargy or restlessness, mucosal bleeding, rising hematocrit with rapidly falling platelet count 1, 2
• Monitor for signs of adequate tissue perfusion: normal capillary refill time, warm and dry extremities, well-felt peripheral pulses, return to baseline mental status, adequate urine output (>0.5 mL/kg/hour in adults) 1, 2
• The critical phase typically occurs on days 3-7 of illness when plasma leakage can rapidly progress to shock 3, 2

Management of Complications

Refractory Shock

• For persistent tissue hypoperfusion despite adequate fluid resuscitation, initiate vasopressors 2
• Use epinephrine for cold shock with hypotension 2
• Use norepinephrine for warm shock with hypotension 2
• Target mean arterial pressure appropriate for age and maintain ScvO2 >70% 2

Significant Bleeding

• Blood transfusion may be necessary for major hemorrhage 1, 2
• Bleeding typically occurs in the context of profound shock combined with thrombocytopenia, hypoxia, and acidosis 4

Critical Pitfalls to Avoid

• Do not administer routine bolus IV 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 2
• Stop fluid resuscitation immediately if signs of fluid overload develop (hepatomegaly, pulmonary rales, respiratory distress) and switch to inotropic support 2
• Do not delay fluid resuscitation in patients showing signs of shock—cardiovascular collapse may rapidly follow 2
• Do not fail to recognize the critical phase when plasma leakage can rapidly progress to shock 2
• Never use aspirin or NSAIDs when dengue cannot be excluded 1, 2

Discharge Criteria

Patients can be safely discharged when ALL of the following are met: 1

• Afebrile for ≥48 hours without antipyretics
• Resolution or significant improvement of symptoms
• Stable hemodynamic parameters for ≥24 hours without support
• Adequate oral intake and urine output (>0.5 mL/kg/hour in adults)
• Laboratory parameters returning to normal ranges

Post-Discharge Instructions

• Monitor and record temperature twice daily 1
• Return immediately if temperature rises to ≥38°C on two consecutive readings or if any warning signs develop 1

Special Populations

• For pregnant women, acetaminophen remains the safest analgesic option 1, 3
• Test pregnant women by NAAT for both dengue and Zika virus due to risk of adverse outcomes 1
• In children, calculate acetaminophen dosing carefully based on weight (10-15 mg/kg per dose) 3