Background: Dengue and chikungunya are emerging arboviral diseases causing substantial morbidity in tropical regions, and  appropriate analgesia is central to supportive care. Bangladesh has experienced escalating outbreaks, yet systematic data on clinician adherence to the national analgesia guideline are scarce. This study assessed adherence to the Directorate General of Health Services (DGHS) guideline for initial analgesia management in adults with suspected dengue or chikungunya at a Bangladeshi tertiary hospital. Methods: This retrospective record-based study reviewed 316 consecutive eligible adults (≥18 years) presenting with acute febrile illness diagnosed as dengue or chikungunya at Fever clinic of Dhaka Medical Hospital, Dhaka, between July and December 2025. Analgesic prescriptions, paracetamol dosing, route, and contraindicated drug use were compared with the DGHS 2018 guideline. Multivariable logistic regression with collinearity assessment was used to identify independent predictors of adherence. Results: Complete adherence was observed in 76.3% (n=241) of patients; partial adherence in 13.9% (n=44); and non-adherence in 9.8% (n=31). Paracetamol was prescribed in 87.0% (n=275) of cases, but weight based dosing (15 mg/kg/dose) was achieved in successfully in majority of cases 64.6% (n=204). Among 59 patients who received NSAIDs, the most common documented justifications were pain unresponsive to paracetamol (33.9%) and pre-existing rheumatological conditions (32.2%). Prescriber designation (consultant vs medical officer: aOR=8.12, 95% CI 1.87–35.31, p=0.005) and laboratory confirmation of diagnosis (aOR=2.94, 95% CI 1.52–5.68, p=0.001) were independent predictors of adherence. Conclusion: Adherence to the national analgesia guideline was satisfactory but suboptimal, with inadequate weight-based paracetamol dosing and avoidable NSAID prescriptions persisting, particularly among junior clinicians. argeted education and decision-support tools are warranted.