From the Guidelines
Treatment for mononucleosis in a 19-year-old female should primarily involve supportive care, as antiviral medications like acyclovir have not shown benefit in clinical trials 1. The patient should be advised to get plenty of rest and avoid strenuous activities and contact sports for at least 3-4 weeks to prevent potential splenic rupture. For symptom management, the following can be recommended:
- Acetaminophen (Tylenol) 650 mg every 6 hours or ibuprofen (Advil, Motrin) 400-600 mg every 6-8 hours for fever and pain relief
- Adequate hydration, aiming for at least 2-3 liters of fluid daily
- Warm salt water gargles (1/2 teaspoon salt in 8 oz warm water) several times daily to help with sore throat discomfort If severe throat swelling occurs, a short course of corticosteroids like prednisone 40-60 mg daily for 5-7 days may be prescribed by a healthcare provider 1. It is essential to note that antibiotics are not effective against mono since it's caused by the Epstein-Barr virus. The patient should avoid alcohol completely during recovery as it can stress the liver, which may already be affected by the virus. Most patients can gradually return to normal activities as symptoms improve, but should continue to avoid heavy lifting and contact sports until cleared by a healthcare provider. In some cases, corticosteroids may be beneficial in selected patients with neurologic complications, but this should be determined on a case-by-case basis 1.
From the Research
Treatment Options for Mononucleosis
- The treatment for mononucleosis is mainly supportive, focusing on managing symptoms and preventing complications 2, 3, 4.
- Reduction of activity and bed rest as tolerated are recommended, and patients should avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2, 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to quickly resolve symptoms associated with EBV-induced infectious mononucleosis, especially in patients with atopic predispositions 5.
- Glucocorticoids and antivirals do not reduce the length or severity of illness, and are not typically used as treatment for mononucleosis 3.
Symptomatic Relief
- Symptomatic relief is the mainstay of treatment for mononucleosis, and may include pain management and fever reduction 3, 4.
- Patients with mononucleosis may experience a range of symptoms, including fever, sore throat, fatigue, and lymphadenopathy, which can be managed with supportive care 2, 3, 4.
Prevention of Complications
- Splenic rupture is a potentially life-threatening complication of mononucleosis, and patients should be advised to avoid physical activity that may increase the risk of rupture 2, 3, 4.
- Patients with immunosuppression are at increased risk of fulminant EBV infection and should be closely monitored 3.
- Airway obstruction is a common cause of hospitalization in children with mononucleosis, and patients should be monitored for signs of respiratory distress 3.