From the Guidelines
Treatment for infectious mononucleosis (mono) primarily involves supportive care, as antiviral medications like acyclovir have been shown to provide little or no benefit in the treatment of infectious mononucleosis 1. The infection is self-limiting and typically resolves within 2-4 weeks. Rest is essential during the acute phase, with gradual return to normal activities as symptoms improve. For symptom management, acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) can help reduce fever and relieve sore throat pain. Adequate hydration and a soft, nutritious diet are important for recovery. Gargling with warm salt water (1/2 teaspoon salt in 8 ounces of water) several times daily can soothe throat discomfort. Some patients may benefit from corticosteroids, such as prednisone, in cases of significant tonsillar swelling causing airway obstruction or extreme difficulty swallowing, as suggested by anecdotal reports of their use in neurologic complications of Epstein-Barr virus infection 1. However, corticosteroids are not standard treatment and should be considered on a case-by-case basis. Contact sports and heavy lifting should be avoided for at least 3-4 weeks to prevent splenic rupture, as splenomegaly is common. Patients should seek immediate medical attention for severe abdominal pain, as this could indicate splenic rupture requiring emergency intervention. Key aspects of care include:
- Supportive care as the main treatment approach
- Symptom management with acetaminophen or ibuprofen
- Rest and gradual return to activities
- Adequate hydration and nutrition
- Avoidance of contact sports and heavy lifting to prevent splenic rupture
- Consideration of corticosteroids in severe cases with airway compromise or significant swallowing difficulty.
From the Research
Treatment Guideline for Infectious Mononucleosis (Mono)
- The treatment for infectious mononucleosis is mainly supportive, focusing on relieving symptoms and managing complications 2, 3.
- Rest and reduction of activity are recommended, with patients advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2.
- Symptomatic relief is the mainstay of treatment, with analgesic or antipyretic drugs used to relieve symptoms such as fever, headache, and general fatigue 4, 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective in quickly improving symptoms, particularly in patients with atopic predispositions 4.
- Glucocorticoids and antivirals do not reduce the length or severity of illness, and their use is not universally recommended 3, 5.
- Steroids may be used for their anti-inflammatory effects, but there is insufficient evidence to support their efficacy for symptom control in infectious mononucleosis 5.
Management of Complications
- Splenic rupture is a potentially life-threatening complication, and patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2, 3.
- Airway obstruction is a common cause of hospitalization, particularly in children 3.
- Patients with immunosuppression are at increased risk of fulminant EBV infection and should be closely monitored 3.
Diagnosis and Prevention
- Diagnosis is typically made based on clinical presentation and laboratory tests, including heterophile antibody tests and EBV-specific antibody profiles 2, 3, 6.
- Prevention of EBV infection and infectious mononucleosis is challenging, but the development of an effective vaccine could provide long-term immunity 2, 6.