From the Guidelines
The treatment for infectious mononucleosis is primarily supportive care, focusing on rest, hydration, and symptom management, as antiviral medications like acyclovir have not shown significant benefit in clinical trials 1. The primary goal is to alleviate symptoms and prevent complications, rather than targeting the virus directly. Key components of supportive care include:
- Rest for 2-4 weeks, with gradual return to normal activities
- Adequate hydration to prevent dehydration
- Over-the-counter pain relievers such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) to manage fever and sore throat
- Gargling with warm salt water (1/2 teaspoon salt in 8 ounces of water) several times daily to provide throat relief
- Avoiding contact sports for at least 3-4 weeks to prevent splenic rupture, as the spleen often enlarges during infection In severe cases with significant throat swelling or breathing difficulties, corticosteroids like prednisone (40-60mg daily for 5-7 days) may be prescribed 1. However, antibiotics are not effective against the Epstein-Barr virus that causes mono, but may be needed if a secondary bacterial infection develops. Most patients recover completely within 2-4 months, though fatigue may persist longer in some cases.
From the Research
Treatment for Infectious Mononucleosis
The treatment for infectious mononucleosis is mainly supportive, focusing on relieving symptoms and managing complications. Key aspects of treatment include:
- Reduction of activity and bed rest as tolerated 2
- Avoiding contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2
- Symptomatic treatment, including adequate hydration, analgesics, and antipyretics 3
- Corticosteroids may be beneficial for patients with respiratory compromise or severe pharyngeal edema, but are not recommended for routine treatment 3, 4
Role of Antiviral Agents
The use of antiviral agents in treating infectious mononucleosis is controversial, with limited evidence supporting their effectiveness:
- A review of randomized controlled trials found that antiviral agents may reduce the time to clinical recovery and duration of lymphadenopathy, but the quality of evidence is very low 5
- Antiviral agents such as acyclovir, valomaciclovir, and valacyclovir have been studied, but their effectiveness is uncertain 5
Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs may be effective in quickly resolving symptoms associated with EBV-induced infectious mononucleosis, particularly in patients with atopic predispositions:
- A case report found that NSAIDs such as tiaramide or loxoprofen improved symptoms quickly after initiation 6
- The immunosuppressive property of NSAIDs may help suppress the activity of lymphocytes and provide rapid and persistent remission of the disease 6
Steroids for Symptom Control
The use of steroids for symptom control in infectious mononucleosis is not universally recommended, with limited evidence supporting their effectiveness:
- A review of randomized controlled trials found that steroids may reduce sore throat at 12 hours, but the benefit is not maintained, and there is insufficient evidence to support their use for symptom control 4
- Steroids may be associated with adverse events, including respiratory distress and acute onset of diabetes, although the association is not definite 4