From the Guidelines
The treatment for mononucleosis primarily focuses on supportive care, as antiviral agents like Aciclovir have no proven role in ameliorating the course of the infection in otherwise healthy individuals 1.
Supportive Care
The main goal of treatment is to manage symptoms and prevent complications. This includes:
- Resting for several weeks to allow the body to recover
- Using over-the-counter pain relievers like acetaminophen or ibuprofen to manage fever and sore throat symptoms
- Staying hydrated, especially if swallowing is painful
- Gargling with salt water to provide temporary relief for sore throat
- Avoiding strenuous activities and contact sports for at least 4-6 weeks to prevent spleen rupture
Corticosteroids
Corticosteroids like prednisone may be prescribed in severe cases with significant throat swelling, but are not routinely recommended 1. They may be beneficial in selected patients with neurologic complications, but their use should be cautious and based on individual patient needs.
Antibiotics
Antibiotics are not effective against the Epstein-Barr virus that causes mono and should only be used if there's a secondary bacterial infection.
Recovery
Most people recover completely within 2-4 weeks, though fatigue may persist longer. The supportive approach works because mono is caused by a virus that must run its course while the immune system develops antibodies to fight the infection.
From the Research
Treatment for Mononucleosis
The treatment for mononucleosis typically involves managing symptoms and supporting the body's immune system as it fights off the infection.
- Rest and hydration are essential for recovery, as well as a healthy diet to help the body recover from the illness.
- Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help alleviate symptoms like fever and sore throat.
- In some cases, corticosteroids may be prescribed to reduce swelling in the throat or to treat other complications, as seen in a study where the use of systemic corticosteroids during EBV-induced infectious mononucleosis was found to be generally safe, at least with concomitant antibiotic therapy 2.
- However, the use of corticosteroids in treating mononucleosis is still a topic of debate, with some studies suggesting that they may not be effective in reducing the duration of symptoms or preventing complications 3, 4.
- Antibiotics are not typically used to treat mononucleosis, as the infection is caused by a virus, but they may be prescribed if there is a secondary bacterial infection, such as strep throat.
- In rare cases, mononucleosis can lead to more serious complications, such as hepatitis or myocarditis, which may require hospitalization and treatment with corticosteroids or other medications, as reported in a case study where a patient with infectious mononucleosis complicated by acute hepatitis and myocarditis responded to corticosteroids 5.
Medication-Related Considerations
When it comes to medication, there are some important considerations for individuals with mononucleosis:
- Amoxicillin, a common antibiotic, has been associated with a rash in some patients with mononucleosis, although the incidence is lower than previously reported, at around 29.5% 6.
- Other medications, such as acetaminophen or ibuprofen, can help manage symptoms like fever and pain, but it's essential to follow the recommended dosage and consult with a healthcare provider before taking any medication.
Additional Considerations
It's also important to note that:
- Mononucleosis can lead to prolonged fatigue and other symptoms, even after the initial illness has resolved, and some studies suggest that certain risk factors, such as poor physical functioning, may be associated with a longer recovery time 4.
- A systematic review of cohort studies and intervention trials found that there is limited evidence to support the use of drug therapy to shorten recovery time, but that allowing patients to resume activity as soon as they feel able may be beneficial 4.