Chikungunya medical therapy

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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 Adapted from Guidelines on Clinical Management of Chikungunya Fever © WHO 2008

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. It is important to identify patients with severe dehydration, as this patients should be carefully observed and rapid rehydration therapy should be started.

Severe dehydration	Mild or Moderate dehydration
Characterized by two of these signs: 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)	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.

Antibiotic Therapy

• Use hydroxychloroquine 200 mg orally once daily or chloroquin phosphate 300 mg orally per day for a period of four weeks in cases where arthralgia is refractory to other drugs.
• Before using chloroquine or related compounds in these doses, the peripheral blood smear examination must be done at least twice to rule out malaria.

Additional 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

• CDC Chikungunya virus