Kelleni’s protocol incorporating non-steroidal anti-inflammatory drugs and nitazoxanide to early manage dengue virus disease: An antiviral silver bullet

Abstract

The current recommendation to avoid non-steroidal anti-inflammatory drugs (NSAIDs) in the management of dengue virus disease (DVD) is scientifically considered of very low to low certainty, despite being widely adopted worldwide. The same recommendation, initially made during the coronavirus disease 2019 (COVID-19) pandemic, was subsequently proven incorrect. In this clinical report, we present evidence, for the first time globally, from a real-life practice that NSAIDs may actually be lifesaving in the early management of DVD as they have proved to be in COVID-19. Moreover, we propose that the personalized immune-modulatory Kelleni’s protocol, which includes nitazoxanide as a key component, can be safely and effectively used to manage various separate or concomitant viral infections and co-infections, including DVD. Importantly, this article contributes to the current medical knowledge in the global pursuit of a safe and effective broad-spectrum antiviral protocol that can be used to early manage multiple highly infectious viruses. However, it’s crucial that sufficiently powered controlled randomized clinical trials be conducted to thoroughly assess and evaluate the safety of NSAIDs in the early management of DVD as well as the efficacy of nitazoxanide with or without NSAIDs in its management.

Keywords: COVID-19; Dengue; Influenza; Kelleni’s protocol; Norovirus; SARS-CoV-2; Respiratory syncytial virus

Core Tip: Dengue virus disease (DVD) is estimated to affect up to 400 million people globally every year. The World Health Organization considers it the fastest growing mosquito-borne infection, and recently the infection has surpassed its historic transmission area. Unfortunately, there is no approved specific antiviral therapy to manage it. In this article, we argue that non-steroidal anti-inflammatory drugs and Kelleni's antiviral protocol could be easily repurposed to manage early DVD and prevent its progression to dengue hemorrhagic fever and death, as it has done with severe acute respiratory syndrome coronavirus 2 and other viruses. Kelleni's protocol has proven to be life-saving for patients of all ages in real-world practice, and it could be seen as an ideal empiric broad-spectrum antiviral Holy Grail that is much needed in our clinical practice.