A 7-year-old child from Mumbai presents with fever, myalgia, and a maculopapular rash on day 5 of illness. Platelet count is 80,000/μL, and NS1 antigen is positive. A diagnosis of dengue fever is confirmed. What is the drug of choice for symptomatic management of pain and fever in this child?

Explanation

## Fever and Pain Management in Dengue **Key Point:** Paracetamol (acetaminophen) is the first-line antipyretic and analgesic agent for dengue fever in children. NSAIDs and aspirin are contraindicated due to increased bleeding risk. ### Rationale for Paracetamol **High-Yield:** Paracetamol is preferred because: 1. Does NOT inhibit platelet function or coagulation cascade 2. Safe in thrombocytopenia (common in dengue) 3. Effective antipyretic and analgesic 4. Recommended dose: 10–15 mg/kg per dose, max 4 g/day ### Why NSAIDs and Aspirin Are Contraindicated | Agent | Mechanism of Harm | Clinical Risk | |-------|-------------------|---------------| | **Aspirin** | Irreversible platelet inhibition | Increased hemorrhage risk, GI bleeding | | **Ibuprofen** | COX inhibition → platelet dysfunction | Bleeding tendency, renal impairment risk | | **Naproxen** | COX inhibition + long half-life | Prolonged bleeding risk, GI toxicity | **Clinical Pearl:** Dengue patients are at risk for dengue hemorrhagic fever (DHF) with spontaneous bleeding; NSAIDs and aspirin further impair hemostasis and are absolutely avoided. **Warning:** Many parents and even junior physicians mistakenly use aspirin in dengue — this is a common exam trap and a dangerous clinical error.