From the Research
Mono, or infectious mononucleosis, is primarily treated with supportive care since it's caused by a virus (usually Epstein-Barr virus) that must run its course. The most recent and highest quality study on this topic is from 2024 1, which provides an updated review of the clinical manifestations, evaluation, diagnosis, and management of infectious mononucleosis. According to this study, treatment is mainly supportive, with reduction of activity and bed rest as tolerated recommended. Patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present. Some key points to consider in the treatment of mono include:
- Rest is the most important treatment, often requiring several weeks for full recovery
- Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be used to manage fever and sore throat pain
- Staying hydrated by drinking plenty of fluids and using warm salt water gargles (1/4 teaspoon salt in 8 ounces warm water) several times daily can help soothe throat discomfort
- Avoiding strenuous activities and contact sports for at least 4 weeks or until cleared by a doctor is recommended, as mono can cause spleen enlargement which risks rupture if injured
- In severe cases with significant throat swelling, a doctor might prescribe a short course of corticosteroids like prednisone, although the evidence for this is limited and there are potential risks associated with steroid use, as highlighted in a 2021 study 2
- Antibiotics are not effective against mono since it's viral, but may be prescribed if a secondary bacterial infection develops. It's also important to note that most people recover completely within 2-4 weeks, though fatigue can persist longer, and if symptoms worsen significantly, especially difficulty breathing or severe abdominal pain, immediate medical attention should be sought. A 2015 study 3 found that there is insufficient evidence to support the use of steroids for symptom control in infectious mononucleosis, and a 2006 study 4 also found that the evidence for steroid use in this context is limited and of poor quality. Overall, the best approach to treating mono is to focus on supportive care and manage symptoms as they arise, rather than relying on steroid treatment or other interventions that may have limited evidence to support their use.