Treatment for Infectious Mononucleosis (Mono)
The treatment for infectious mononucleosis (Mono) is primarily supportive care, as there is no specific antiviral therapy routinely recommended for this self-limited condition. 1, 2
Diagnosis Confirmation
Before initiating treatment, confirm the diagnosis with:
- Complete blood count with differential (looking for >40% lymphocytes and >10% atypical lymphocytes)
- Heterophile antibody test (Monospot test) - sensitivity 87%, specificity 91%
- Note: False negatives may occur in children <5 years and adults in the first week of illness
- If heterophile test is negative but clinical suspicion remains high, check for elevated liver enzymes or consider EBV viral capsid antigen antibody testing 3
Supportive Care Treatment Protocol
First-line Management
- Adequate hydration to prevent dehydration
- Analgesics/antipyretics for fever and pain control:
- Acetaminophen for fever and sore throat
- NSAIDs for myalgias and pharyngeal discomfort
- Adequate rest guided by the patient's energy level (do not enforce strict bed rest) 2
Activity Restrictions
- Avoid contact sports or strenuous exercise for at least 3-8 weeks or while splenomegaly is present
- Return to normal activities should be gradual and based on patient's energy levels
- Shared decision-making should guide return to athletic activity 3, 4
Monitoring for Complications
- Monitor for signs of splenic enlargement
- Assess for respiratory compromise or severe pharyngeal edema that might require additional intervention
- Be alert for rare complications such as spontaneous splenic rupture (0.1-0.5% of cases) 1
Special Considerations
When to Consider Corticosteroids
Corticosteroids are not recommended for routine treatment but may be beneficial in specific situations:
- Severe pharyngeal edema with risk of airway obstruction
- Significant respiratory compromise
- Massive splenomegaly
- Hemolytic anemia or severe thrombocytopenia 2
Medications Not Routinely Recommended
- Antivirals (including acyclovir): Not effective for routine EBV infectious mononucleosis
- Antihistamines: No proven benefit
- Routine corticosteroids: Not indicated unless specific complications present 2
Patient Education
- Inform patients that fatigue may persist for several months after acute infection resolves
- Advise about the risk of splenic rupture and importance of avoiding contact sports
- Explain that EBV is primarily transmitted through saliva ("kissing disease")
- Reassure that most patients have an uneventful recovery 1, 4
Follow-up
- Clinical reassessment at 3-4 weeks to evaluate for resolution of splenomegaly before clearing for contact sports
- Additional follow-up as needed for persistent symptoms
- Most patients will have complete resolution of symptoms within 2-4 weeks, though fatigue may persist longer 4
The prognosis for infectious mononucleosis is generally excellent, with most patients experiencing complete recovery without specific antiviral treatment. The focus should remain on supportive care and monitoring for rare complications.