A 7-year-old child from Delhi presents with fever, myalgia, and rash on day 5 of illness. Laboratory tests confirm dengue fever with platelet count of 80,000/μL and no evidence of dengue hemorrhagic fever. What is the drug of choice for symptomatic management?

Explanation

## Symptomatic Management of Dengue in Children **Key Point:** Paracetamol (acetaminophen) is the drug of choice for fever and pain management in dengue fever across all age groups, including children. ### Rationale for Paracetamol 1. **Safety Profile**: Does not increase bleeding risk or platelet dysfunction 2. **Mechanism**: Acts as an analgesic and antipyretic without affecting hemostasis 3. **Dosing**: 10–15 mg/kg/dose every 4–6 hours (max 5 doses/day, <60 mg/kg/day) 4. **WHO Recommendation**: Endorsed by WHO and Indian Academy of Pediatrics for dengue management ### Why NSAIDs Are Contraindicated | Feature | Paracetamol | NSAIDs (Aspirin, Ibuprofen) | |---------|-------------|-----------------------------| | Platelet function | No effect | Inhibits platelet aggregation | | Bleeding risk | Safe | **Increases hemorrhage risk** | | GI irritation | Minimal | Significant | | Use in dengue | **First-line** | **Contraindicated** | **High-Yield:** NSAIDs (aspirin, ibuprofen, indomethacin) are absolutely contraindicated in dengue because they: - Inhibit platelet function - Increase risk of bleeding and hemorrhagic manifestations - Cause gastric irritation (risk of GI bleed in thrombocytopenia) **Clinical Pearl:** Even in dengue without hemorrhagic features, NSAIDs should be avoided because dengue can progress to hemorrhagic phase unpredictably. Paracetamol remains safe throughout the disease course. **Warning:** Many parents and practitioners incorrectly use aspirin or ibuprofen in dengue thinking they are "stronger" antipyretics — this is a common trap in pediatric dengue management.