From the FDA Drug Label
Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection
The discharge instructions for a patient diagnosed with infectious mononucleosis (mono) who will be prescribed steroids should include:
- Monitoring for signs of infection: The patient should be aware of the increased risk of infection and monitor for signs of infection, such as fever, chills, or worsening symptoms.
- Gradual reduction of dosage: To minimize the risk of adrenocortical insufficiency, the dosage of prednisone should be gradually reduced when discontinuing therapy 1.
- Hepatitis B screening: The patient should be screened for hepatitis B infection before initiating immunosuppressive treatment with prednisone 1.
- Varicella and measles precautions: The patient should take precautions to avoid exposure to varicella and measles, and consider prophylaxis with varicella zoster immune globulin or immunoglobulin if exposed 1.
- Follow-up appointments: The patient should have follow-up appointments to monitor for potential side effects and adjust the treatment plan as needed. The patient should be advised to seek medical attention immediately if they experience any signs of infection or other concerning symptoms 1.
From the Research
For a patient diagnosed with infectious mononucleosis (mono) who will be prescribed steroids, discharge instructions should prioritize rest, hydration, and monitoring for complications to minimize morbidity, mortality, and improve quality of life. The patient should take the prescribed steroid medication, typically prednisone, exactly as directed, usually for a short course of 5-7 days at doses ranging from 40-60mg daily, tapering as instructed 2. Rest is essential; avoid strenuous physical activity and contact sports for at least 8 weeks to prevent splenic rupture, as the spleen may be enlarged, as suggested by the most recent and highest quality study 3. Stay hydrated and maintain adequate nutrition while avoiding alcohol completely until fully recovered. Take acetaminophen (Tylenol) for fever and pain as needed, but avoid aspirin and NSAIDs due to potential liver complications. Monitor for worsening symptoms such as severe abdominal pain, difficulty breathing, or extreme weakness, which require immediate medical attention. The steroids are prescribed to reduce severe throat inflammation and swelling that may compromise breathing, but they don't shorten the overall illness duration, which typically lasts 2-4 weeks. Follow up with your healthcare provider as scheduled to monitor recovery and determine when normal activities can safely resume. It's also important to note that while steroids may provide some symptom relief, there is insufficient evidence to support their efficacy for symptom control in infectious mononucleosis 2, and their use should be weighed against potential side effects and long-term complications. Given the rare but potentially fatal complication of splenic rupture, particular vigilance is required in men under 30 within 4 weeks of symptom onset 3. In cases where the patient wishes to return to high-risk activities prior to the recommended 8-week period, an ultrasound scan (USS) should be performed to ensure resolution of splenomegaly 3.