From the Guidelines
Treatment for acute Epstein-Barr virus (EBV) infection is primarily supportive care, as there is no specific antiviral therapy proven effective against EBV. According to the Infectious Diseases Society of America guidelines 1, acyclovir, which inhibits replication of Epstein-Barr virus in vitro, did not show benefit in the treatment of infectious mononucleosis. The guidelines suggest that corticosteroids may be beneficial in selected patients with neurologic complications of EBV infection, including encephalomyelitis, particularly in cases with increased intracranial pressure 1.
Supportive Care Measures
- Patients should focus on adequate rest and hydration to help their immune system recover from the infection.
- Over-the-counter pain relievers such as acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) can be used to manage fever and sore throat symptoms.
- Severe throat pain may require short-term corticosteroids like prednisone (40-60 mg daily for 5-7 days with a taper) in select cases, though this is not routine.
- Patients should avoid contact sports and strenuous activity for at least 3-4 weeks to prevent splenic rupture, as splenomegaly is common.
- Alcohol consumption should be avoided during the illness and recovery period to prevent additional liver stress, as EBV can cause hepatitis.
Monitoring and Follow-Up
- Most patients recover completely within 2-4 weeks, though fatigue may persist longer.
- Regular follow-up with a healthcare provider is essential to monitor for any potential complications and to adjust the treatment plan as needed.
- These supportive measures allow the body's immune system to naturally clear the active infection while minimizing complications and discomfort during the recovery process.
From the Research
Treatment Options for Acute EBV
- Antiviral treatment for severe EBV infections in apparently immunocompetent patients is debatable, but physicians may consider using antiviral agents as an adjunct to steroid treatment 2
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can quickly resolve symptoms associated with EBV-induced infectious mononucleosis in patients with atopic predispositions 3
- Corticosteroid therapy can be used to treat impending upper airway obstruction due to EBV infectious mononucleosis, and can help resolve fever and lymphadenopathy more quickly 4
Antiviral Medications
- Acyclovir monotherapy is the most commonly prescribed antiviral regimen for severe EBV infections 2
- Other antiviral medications that have been used to treat EBV infections include ganciclovir, foscarnet, and vidarabine 2
- Novel anti-EBV compounds, such as maribavir, are being developed for the treatment of acute EBV infections 5