Chikungunya medical therapy: Difference between revisions
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There is no specific antiviral therapy for [[Chikungunya causes|chikungunya virus]]. The treatment of the disease is based on decreasing the symptoms. | There is no specific antiviral therapy for [[Chikungunya causes|chikungunya virus]]. The treatment of the disease is based on decreasing the symptoms. | ||
The treatment for chikungunya infection is symptomatic | ==Medical Therapy for the Acute Phase== | ||
The treatment for chikungunya infection is symptomatic and the initial therapy focuses on decrease the symptoms. It is important to evaluate for other serious conditions (such as [[dengue]], [[malaria]], or bacterial infections) and treat or manage appropriately. | |||
* | ===Hydration=== | ||
* Assess hydration and hemodynamic status and provide proper [[Oral rehydration therapy|rehydration therapy]] (preferably oral) instituted quickly. | |||
Severe dehydration is characterized by two of these signs: | |||
• abnormal sensorium, excessive sleepiness or lethargy | |||
• sunken eyes | |||
• poor fluid intake | |||
• dry, parched tongue | |||
• reduced skin turgor (very slow skin pinch taking more than 2 sec to | |||
retract) | |||
Mild or Moderate dehydration is characterized by two of these signs: | |||
• restlessness or irritability | |||
• sunken eyes | |||
• dry tongue | |||
• excessive thirst | |||
• slow skin pinch (less than 2 seconds to retract) | |||
===Management of Symptoms === | |||
* Administer [[Paracetamol]] 1g PO q6-8h a day to treat the fever, headache and pain. | |||
* Paracetamol must be used with caution in persons with preexisting underlying serious illnesses. | |||
* Children may be given 50-60 mg/kg/day divided q6-8h. | |||
* Administer [[antihistamines]] for itching. | |||
* Tepid sponging can be suggested. | |||
* If inadequate, consider using [[narcotics]] or [[NSAIDs]]. | * If inadequate, consider using [[narcotics]] or [[NSAIDs]]. | ||
* If [[dengue]] is suspected, do not use [[aspirin]] or other [[NSAIDs]] (e.g., [[ibuprofen]], [[naproxen]], [[toradol]]) until they have been afebrile ≥48 hours and have no warning signs for severe [[dengue]]. | * If [[dengue]] is suspected, do not use [[aspirin]] or other [[NSAIDs]] (e.g., [[ibuprofen]], [[naproxen]], [[toradol]]) until they have been afebrile ≥48 hours and have no warning signs for severe [[dengue]]. | ||
* Persistent [[joint pain]] may benefit from use of [[NSAIDs]], [[corticosteroids]], or [[physiotherapy]]. | * Persistent [[joint pain]] may benefit from use of [[NSAIDs]], [[corticosteroids]], or [[physiotherapy]]. | ||
===Other Measures== | |||
* Heat may increase/worsen [[joint pain]] and is therefore best to avoid during acute stage. | |||
* Mild forms of [[exercise]] and [[physiotherapy]] are recommended in recovering persons. | |||
* Patients may be encouraged to walk, use their hands for eating, writing and regular isotonic exercises. | |||
* Cold compresses may be suggested depending on the response. | |||
* Exposure to warm environments (morning and evening sun) may be suggested as the acute phase subsides. | |||
==References== | ==References== | ||
Revision as of 18:34, 17 June 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2], Alonso Alvarado, M.D. [3]
Overview
There is no specific antiviral therapy for chikungunya virus. The treatment of the disease is based on decreasing the symptoms.
Medical Therapy for the Acute Phase
The treatment for chikungunya infection is symptomatic and the initial therapy focuses on decrease the symptoms. It is important to evaluate for other serious conditions (such as dengue, malaria, or bacterial infections) and treat or manage appropriately.
Hydration
- Assess hydration and hemodynamic status and provide proper rehydration therapy (preferably oral) instituted quickly.
Severe dehydration is characterized by two of these signs: • abnormal sensorium, excessive sleepiness or lethargy • sunken eyes • poor fluid intake • dry, parched tongue • reduced skin turgor (very slow skin pinch taking more than 2 sec to retract) Mild or Moderate dehydration is characterized by two of these signs: • restlessness or irritability • sunken eyes • dry tongue • excessive thirst • slow skin pinch (less than 2 seconds to retract)
Management of Symptoms
- Administer Paracetamol 1g PO q6-8h a day to treat the fever, headache and pain.
- Paracetamol must be used with caution in persons with preexisting underlying serious illnesses.
- Children may be given 50-60 mg/kg/day divided q6-8h.
- Administer antihistamines for itching.
- Tepid sponging can be suggested.
- If inadequate, consider using narcotics or NSAIDs.
- If dengue is suspected, do not use aspirin or other NSAIDs (e.g., ibuprofen, naproxen, toradol) until they have been afebrile ≥48 hours and have no warning signs for severe dengue.
- Persistent joint pain may benefit from use of NSAIDs, corticosteroids, or physiotherapy.
=Other Measures
- Heat may increase/worsen joint pain and is therefore best to avoid during acute stage.
- Mild forms of exercise and physiotherapy are recommended in recovering persons.
- Patients may be encouraged to walk, use their hands for eating, writing and regular isotonic exercises.
- Cold compresses may be suggested depending on the response.
- Exposure to warm environments (morning and evening sun) may be suggested as the acute phase subsides.