Treatment for Infectious Mononucleosis (Mono)
The treatment for infectious mononucleosis is primarily supportive care, including adequate hydration, analgesics, antipyretics, and appropriate rest guided by the patient's energy level. 1, 2
Diagnosis
Before initiating treatment, confirm the diagnosis with:
- Clinical presentation: Sore throat, significant fatigue, fever, and lymphadenopathy (particularly posterior cervical or auricular)
- Laboratory findings:
- Complete blood count showing lymphocytosis (≥50%) with atypical lymphocytes (≥10%)
- Positive heterophile antibody test (Monospot)
- If heterophile test is negative but suspicion remains high, test for Epstein-Barr virus (EBV) viral capsid antigen antibodies 3
Supportive Treatment Protocol
First-line Management
- Hydration: Ensure adequate fluid intake
- Pain control: Acetaminophen or NSAIDs for sore throat, fever, and myalgias
- Rest: Allow for adequate rest based on patient's energy level; bed rest should not be enforced 1
- Activity modification: Avoid contact sports and strenuous exercise for at least 4-8 weeks or while splenomegaly is present 2, 3
Important Considerations
- Duration of symptoms: Inform patients that fatigue may persist for several months after acute infection resolves 1
- Monitoring for complications: Assess for signs of splenic enlargement, which occurs in approximately 50% of cases 2
What NOT to Do
Avoid routine use of corticosteroids: Not recommended for uncomplicated infectious mononucleosis 3
Avoid routine use of antivirals: Acyclovir is not recommended for standard treatment 1, 3
Avoid antihistamines: Not recommended for routine treatment 1
Special Circumstances
Airway Compromise
- If severe pharyngeal edema threatens airway patency, consider short-course corticosteroids 1
Splenic Rupture
- Occurs in 0.1-0.5% of cases and is potentially life-threatening 2
- Maintain high vigilance for left upper quadrant pain, referred shoulder pain, or signs of shock
- Immediate medical attention required if suspected
Return to Sports
- Athletes should be withdrawn from contact or collision sports for at least 4 weeks after symptom onset 1
- Some guidelines recommend waiting until splenomegaly resolves, which may take up to 8 weeks 2
- Elite athletes may require 3-6 months to regain top form 5
Follow-up
- Monitor for resolution of symptoms
- Assess for splenomegaly before clearing for return to contact sports
- Be aware that fatigue may persist for months despite resolution of other symptoms
By following these supportive care measures and avoiding unnecessary medications, most patients with infectious mononucleosis will recover completely without complications.