From the Research
NSAIDs, including ibuprofen, should not be strictly avoided in dengue fever, and aspirin (ASA) should be avoided due to its higher bleeding risk, as recent evidence suggests that ibuprofen at over-the-counter doses may not significantly increase the risk of bleeding complications. The management of dengue fever primarily focuses on supportive care, including adequate hydration, rest, and monitoring for warning signs of severe disease. For fever and pain management, acetaminophen (paracetamol) is often recommended, typically at a dose of 500-1000 mg every 6 hours for adults, not exceeding 4000 mg per day, and for children, the dose is 10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours 1. However, the most recent and highest quality study suggests reconsidering the contraindication of NSAIDs in dengue treatment, especially ibuprofen, which has a lower bleeding risk compared to other NSAIDs and aspirin 1.
Key considerations in the management of dengue fever include:
- Monitoring for signs of plasma leakage and hemorrhagic complications
- Avoiding medications that could exacerbate bleeding risk, with a particular caution against aspirin due to its known effects on platelet function
- Focusing on supportive care, including fluid resuscitation and symptomatic relief with medications like acetaminophen, while considering the potential benefits and risks of NSAIDs like ibuprofen on a case-by-case basis 1, 2.
It's essential to weigh the risks and benefits of each medication, considering the latest evidence that suggests ibuprofen may not significantly increase bleeding risk in dengue patients, unlike previously thought 1. The quality of evidence regarding corticosteroids in dengue treatment is low to very low, indicating insufficient evidence to support their use in either dengue-related shock or early-stage dengue fever outside of a randomized controlled trial setting 3. Therefore, the primary approach should remain focused on supportive care and careful monitoring, with a nuanced consideration of the role of NSAIDs, particularly ibuprofen, in symptom management.