What is the best treatment for infectious mononucleosis (mono)?

Treatment of Infectious Mononucleosis

The best treatment for infectious mononucleosis (mono) is supportive care, as the condition is generally self-limiting and does not require specific antiviral therapy or corticosteroids for routine management. 1, 2, 3

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis with:

• Complete blood count showing:
  • Atypical lymphocytosis ≥20% OR
  • Atypical lymphocytosis ≥10% plus lymphocytosis ≥50% 1, 2
• Positive heterophile antibody test (Monospot)
• If Monospot is negative but clinical suspicion remains high, order EBV-specific antibodies (VCA IgM and IgG, EBNA) 1

Supportive Care Management

1. Adequate hydration - Ensure sufficient fluid intake to prevent dehydration
2. Analgesics/antipyretics - Use acetaminophen or NSAIDs for fever and pain control 2
3. Rest - Allow adequate rest guided by the patient's energy level rather than enforced bed rest 2, 4
4. Activity restriction - Avoid contact sports or strenuous exercise for at least 3-8 weeks or while splenomegaly is present to prevent splenic rupture 2, 4, 3

When to Consider Corticosteroids

Corticosteroids should NOT be used routinely but may be considered in specific situations:

• Impending airway obstruction
• Severe pharyngeal edema
• Neurological complications
• Other severe complications 1, 5, 6

Medications to Avoid

1. Routine corticosteroids - Not recommended for uncomplicated cases 2, 6
2. Antiviral medications - No proven benefit in infectious mononucleosis 5, 2
3. Antihistamines - Not recommended for routine treatment 2

Monitoring and Follow-up

• Monitor for complications, particularly:
  • Splenic rupture (occurs in 0.1-0.5% of cases) 4
  • Respiratory compromise
  • Neurological complications
  • Persistent symptoms beyond expected timeframe
• Follow up to assess resolution of lymphadenopathy and splenomegaly

Duration and Prognosis

• Most symptoms resolve within 2-4 weeks
• Fatigue may persist for several months after the acute infection 2, 4
• Most patients make a full recovery without specific intervention

Special Considerations

• Immunosuppressed patients are at higher risk for severe disease and complications 3
• Patients should be advised about the risk of transmitting the virus through saliva
• Patients should be informed that fatigue may persist for months after other symptoms resolve

The evidence consistently shows that infectious mononucleosis is best managed with supportive care alone in most cases, with specific interventions reserved only for severe complications or special circumstances.