Treatment of dengue
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WHO dengue clinical management supportive care warning signs fluid treatment guideline
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Treatment of dengue
There is no routinely recommended specific antiviral treatment for dengue. Management is mainly supportive, with careful monitoring to identify plasma leakage, shock, bleeding, or organ involvement early. Recent reviews have not established a proven antiviral, immunomodulatory, or platelet-raising therapy for routine use, including papaya-leaf preparations. Recent systematic review
1. Uncomplicated dengue: home care, under clinician guidance
Appropriate only if the person is alert, can drink adequately, urinates at least every 6 hours, has no warning signs, and has reliable follow-up.
- Fluids: Use oral rehydration solution, soups, water, fruit juice, or other electrolyte-containing fluids. Take small frequent amounts, especially if nauseated.
- Fever/pain: Use paracetamol (acetaminophen) only. Avoid exceeding the labeled or clinician-recommended total daily dose, especially with liver disease or heavy alcohol use.
- Avoid: aspirin, ibuprofen, diclofenac, naproxen, and other NSAIDs because they can increase bleeding and stomach irritation. Avoid self-prescribed steroids and antibiotics.
- Monitoring: Daily review during the illness, especially from about day 3 and when the fever begins to settle. A falling platelet count together with a rising hematocrit can indicate plasma leakage.
Park's Textbook of Preventive and Social Medicine, lines 3096-3109.
2. Go to an emergency department / hospital immediately for warning signs
Risk may increase when fever starts coming down, not only when fever is high.
Seek urgent care for any of the following:
- Severe or persistent abdominal pain
- Persistent vomiting or inability to drink
- Bleeding from gums/nose, vomiting blood, black stools, heavy menstrual bleeding
- Drowsiness, confusion, unusual restlessness, fainting
- Cold, clammy hands or feet, breathing difficulty
- Little or no urine for 4-6 hours
- Marked weakness or rapid deterioration
These signs may reflect severe dengue with leakage, bleeding, or shock. WHO dengue case-management guidance
3. Hospital treatment
Treatment should be directed by clinicians using vital signs, urine output, hematocrit, platelets, and evidence of bleeding or fluid overload.
- IV isotonic crystalloid fluids such as normal saline or Ringer's lactate are used if oral fluids are not tolerated, warning signs develop, or shock occurs.
- Fluid volume must be reassessed frequently. Too little fluid can worsen shock; too much can cause fluid overload and respiratory distress.
- Severe dengue may require high-dependency or intensive care, oxygen/ventilatory support, treatment of organ dysfunction, and blood products for clinically significant bleeding.
- Platelet transfusion is not given solely because the platelet count is low. It is generally considered for significant active bleeding or specific procedures, according to local specialist protocols.
4. Who needs especially early medical assessment
Pregnant people, infants, older adults, and people with diabetes, kidney disease, liver disease, heart disease, obesity, or medicines that affect bleeding such as warfarin, aspirin, or clopidogrel should seek early clinical advice.
Bottom line: Drink fluids, take paracetamol only, avoid NSAIDs/aspirin, and get urgent assessment if warning signs appear. Dengue can worsen as the fever settles.
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