What is the most appropriate medication for an 18-year-old woman with infectious mononucleosis (positive heterophile antibody test), fever, sore throat, and swollen cervical lymph nodes, who has a history of Attention Deficit Hyperactivity Disorder (ADHD) managed with amphetamine (amphetamine) dextroamphetamine and seasonal allergies?

From the Research

The most appropriate medication for this patient's acute condition is ibuprofen for fever and pain management, as it is a supportive care measure for infectious mononucleosis, which is a self-limiting viral illness without specific antiviral treatment. The patient's symptoms, including fever, sore throat, and swollen cervical lymph nodes, are consistent with infectious mononucleosis, as confirmed by the positive heterophile antibody test 1, 2.

The management of infectious mononucleosis primarily involves supportive care, with a focus on relieving symptoms and preventing complications 1, 2. Ibuprofen can be used to manage fever and pain, and the patient should be advised to maintain adequate hydration, get plenty of rest, and use warm salt water gargles for throat discomfort.

It is essential to avoid aspirin due to the risk of Reye's syndrome in young adults with viral infections 2. The patient's amphetamine/dextroamphetamine for ADHD can be continued as prescribed, and for her seasonal allergies, non-sedating antihistamines like cetirizine 10 mg daily can be used if needed.

The patient should avoid contact sports and strenuous physical activity for at least 3-4 weeks to reduce the risk of splenic rupture, which is a rare but serious complication of mononucleosis 1, 2. Acyclovir, clarithromycin, diphenhydramine, and doxylamine are not the most appropriate choices for the management of infectious mononucleosis, as acyclovir is an antiviral medication not typically used for EBV, clarithromycin is an antibiotic not indicated for viral infections, and diphenhydramine and doxylamine are sedating antihistamines that may not be necessary for this patient's seasonal allergies.

Key considerations in the management of infectious mononucleosis include:

• Supportive care with ibuprofen for fever and pain management
• Avoidance of aspirin due to the risk of Reye's syndrome
• Maintenance of adequate hydration and rest
• Use of warm salt water gargles for throat discomfort
• Avoidance of contact sports and strenuous physical activity for at least 3-4 weeks
• Continuation of prescribed medications for ADHD and seasonal allergies, as necessary.