Management of Chikungunya

Introduction to Chikungunya Management

The American Family Physician recommends that nonsteroidal anti-inflammatory drugs (NSAIDs) be avoided in the acute phase of Chikungunya due to the increased risk of hemorrhagic complications, as the virus can cause thrombocytopenia and alter platelet function 1

NSAIDs have antiplatelet effects that can worsen the risk of bleeding in patients with Chikungunya, particularly in the acute phase where thrombocytopenia is common 1
The acute phase of Chikungunya can cause significant dehydration, and NSAIDs can compromise renal function, especially in dehydrated patients, by inhibiting the vasodilatory effects of prostaglandins produced by COX-2 1

The American Family Physician suggests paracetamol/acetaminophen as the first choice for controlling fever and pain in the acute phase of Chikungunya, as it does not have significant antiplatelet effects 1
Adequate hydration is fundamental to prevent renal and cardiovascular complications and to maintain adequate renal function during the febrile phase 1
Rest is important for recovery and reduction of articular symptoms in the acute phase of Chikungunya 1

NSAIDs may be considered after the acute phase (usually after 7-10 days of symptom onset), when viremia has decreased significantly, the risk of hemorrhagic complications is lower, and persistent articular symptoms become the primary issue 1