From the Guidelines
The treatment for mononucleosis primarily involves supportive care as it is a viral infection that typically resolves on its own. Rest is essential, often for several weeks, to allow the body to recover and prevent complications. Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help manage fever and sore throat symptoms 1. Staying hydrated is crucial, especially if swallowing is painful; warm salt water gargles (1/4 teaspoon salt in 8 ounces of water) can provide temporary throat relief. Avoid strenuous activities and contact sports for at least 4-6 weeks, as the spleen may be enlarged and at risk of rupture. Corticosteroids like prednisone may be prescribed in severe cases with significant throat swelling, but are not routine 1. Antibiotics are not effective against the Epstein-Barr virus that causes mono and should only be used if a secondary bacterial infection develops. Most people recover completely within 2-4 weeks, though fatigue may persist longer. The virus remains dormant in the body after recovery but rarely causes symptoms again.
Some key points to consider in the treatment of mononucleosis include:
- Rest and hydration are crucial for recovery
- Over-the-counter pain relievers can help manage symptoms
- Corticosteroids may be prescribed in severe cases
- Antibiotics should only be used if a secondary bacterial infection develops
- Avoid strenuous activities and contact sports for at least 4-6 weeks
It's also important to note that while the provided evidence primarily discusses multiple myeloma and other conditions, the general principles of treating mononucleosis remain the same, focusing on supportive care and managing symptoms until the infection resolves on its own 1.
From the Research
Treatment Overview
- The treatment for mononucleosis is mainly supportive, focusing on relieving symptoms and managing complications 2, 3, 4.
- Reduction of activity and bed rest as tolerated are recommended, with patients advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 3.
- Symptom relief and rest are commonly recommended treatments, with corticosteroid therapy potentially indicated for severe airway obstruction or other severe complications, but should be avoided unless the benefits outweigh potential risks 2, 5.
Medications
- Antiviral medications have been used to treat mononucleosis, but their use is controversial and there is insufficient evidence to support their effectiveness 6.
- Steroids have been used for their anti-inflammatory effects, but there is no universal criteria for their use and insufficient evidence to support their efficacy for symptom control in mononucleosis 5.
- The majority of cases of mononucleosis are self-limiting and require only supportive care, with most patients having an uneventful recovery 2, 3.
Management
- Current guidelines recommend that patients with mononucleosis not participate in athletic activity for three weeks from onset of symptoms, with shared decision-making used to determine the timing of return to activity 4.
- Immunosuppressed populations are at higher risk of severe disease and significant morbidity, and require close monitoring and management 4.
- Prompt diagnosis is essential to avoid unnecessary investigations and treatments and to minimize complications, with the most feared complication being splenic rupture 3.