What is the treatment for Dengue (Dengue Fever)?

Treatment of Dengue Fever

There is no specific antiviral therapy for dengue—treatment is entirely supportive, focusing on aggressive hydration, acetaminophen for symptom control, and careful monitoring to prevent progression to shock. 1

General Management Principles

Symptomatic management is the cornerstone of dengue treatment since no approved antiviral exists. 1, 2 The approach differs dramatically based on disease severity:

• Dengue without warning signs: Outpatient management with aggressive oral hydration (>2,500-3,000 mL daily using any locally available fluids including water, oral rehydration solutions, soup, or rice water—avoid soft drinks due to high osmolality) 1, 3
• Dengue with warning signs: Hospitalization required with close monitoring during the critical phase (days 3-7 of illness) to prevent progression to shock 3
• Severe dengue/dengue shock syndrome: Immediate ICU admission with aggressive fluid resuscitation 1

Pain and Fever Management

Use acetaminophen (paracetamol) exclusively for pain and fever control. 1, 4, 3

Never use aspirin or NSAIDs under any circumstances—they increase bleeding risk through platelet dysfunction and should be stopped immediately when dengue is suspected. 1, 4, 5

Monitoring Requirements

Daily complete blood count monitoring is essential to track platelet counts and hematocrit levels. 1, 4

Watch for warning signs of progression to severe disease: 1, 3

• Severe abdominal pain or persistent vomiting
• Mucosal bleeding
• Lethargy, restlessness, or altered mental status
• Rising hematocrit with rapidly falling platelet count (particularly <100,000/mm³)
• Hepatomegaly
• Clinical fluid accumulation

Fluid Management for Dengue Shock Syndrome

For patients in shock, administer 20 mL/kg of isotonic crystalloid (Ringer's lactate or 0.9% normal saline) as a rapid bolus over 5-10 minutes, with immediate reassessment after each bolus. 1, 3

If shock persists: 1

• Repeat crystalloid boluses up to 40-60 mL/kg in the first hour
• Colloid solutions (gelafundin, albumin, or dextran) achieve faster resolution of shock and require less total volume than crystalloids alone (mean 31.7 mL/kg versus 40.63 mL/kg) 1
• Consider colloids for severe shock with pulse pressure <10 mmHg 1

Monitor for signs of adequate tissue perfusion: 1

• Normal capillary refill time
• Warm, dry extremities with well-felt peripheral pulses
• Return to baseline mental status
• Adequate urine output (>0.5 mL/kg/hour in adults)

Critical Pitfalls to Avoid

Stop fluid resuscitation immediately if hepatomegaly or pulmonary rales develop—switch to inotropic support instead. 1 Overhydration during the recovery phase can cause pulmonary edema. 1

Do not administer routine bolus IV fluids in patients with severe febrile illness who are NOT in shock—this increases risk of fluid overload and respiratory complications without improving outcomes. 1

Do not delay fluid resuscitation once hypotension occurs—cardiovascular collapse may rapidly follow, and delays significantly increase mortality. 1

Recognize the critical phase (days 3-7 of illness) when plasma leakage can rapidly progress to shock. 1

Management of Refractory Shock

For persistent tissue hypoperfusion despite adequate fluid resuscitation: 1, 4

• Cold shock with hypotension: Titrate epinephrine as first-line vasopressor
• Warm shock with hypotension: Titrate norepinephrine as first-line vasopressor
• Target mean arterial pressure appropriate for age and maintain ScvO2 >70%

Management of Bleeding Complications

Blood transfusion may be necessary in cases of significant bleeding. 1, 4 Monitor hemoglobin and hematocrit closely. 3

Discharge Criteria

Patients can be safely discharged when ALL of the following are met: 4, 3

• 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, patients must monitor temperature twice daily and return immediately if fever ≥38°C on two consecutive readings or if any warning signs develop. 4

Special Populations

Pregnant women with confirmed or suspected dengue should be hospitalized due to risk of maternal death, hemorrhage, preeclampsia, and vertical transmission. 4 Acetaminophen remains the safest analgesic option. 4