What is the treatment for infectious mononucleosis (mono)?

Treatment of Infectious Mononucleosis (Mono)

The mainstay of treatment for infectious mononucleosis is supportive care, including adequate rest, hydration, and avoidance of contact sports for at least 8 weeks or while splenomegaly is present. 1

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis with:

• Clinical presentation: Triad of fever, tonsillar pharyngitis, and lymphadenopathy 2
• Laboratory testing:
  • Heterophile antibody test (Monospot) - most widely used initial test 1, 2
  • EBV-specific antibody testing (VCA IgM, VCA IgG, and EBNA IgG panel) if Monospot is negative 1
  • Complete blood count showing lymphocytosis with >10% atypical lymphocytes 2

Supportive Care Treatment Algorithm

First-line Management:

1. Rest and Activity Modification

   • Recommend reduction of activity and rest as tolerated 2
   • Avoid enforced bed rest; let patient's energy level guide activity 3
   • Strictly avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is present 1, 2, 4

2. Symptom Management

   • Pain and fever control: Analgesics and antipyretics 3
   • Hydration: Ensure adequate fluid intake 1, 3
   • Throat discomfort: Salt water gargles, throat lozenges

Monitoring for Complications:

• Splenic rupture (occurs in 0.1-0.5% of cases) - most feared complication 2
  • Monitor for abdominal pain, especially left upper quadrant
  • Assess for splenomegaly (present in approximately 50% of cases) 2
• Airway obstruction due to significant tonsillar hypertrophy 1
• Hematological complications (thrombocytopenia, hemolytic anemia) 1

Special Considerations

Corticosteroids

• Not recommended for routine treatment 1, 3
• May be indicated for:
  • Airway obstruction due to significant tonsillar hypertrophy
  • Severe hematological complications
  • Impending respiratory compromise 1

Antiviral Agents

• Not recommended for routine treatment of uncomplicated infectious mononucleosis 1, 3
• No proven benefit in standard cases 2

Immunocompromised Patients

• Require closer monitoring due to increased risk of:
  • EBV-related lymphoproliferative disorders
  • More severe disease course 1
• Consider reducing immunosuppressive therapy if possible during active infection 5

Duration and Follow-up

• Most symptoms resolve within 2-4 weeks 2
• Fatigue may persist for several months after acute infection 3
• Follow-up to ensure resolution of splenomegaly before clearing for return to contact sports 4

Common Pitfalls to Avoid

1. Prescribing antibiotics without evidence of bacterial superinfection
2. Returning to contact sports too early - risk of splenic rupture is highest within the first month 4
3. Overuse of corticosteroids for routine cases
4. Ignoring persistent symptoms that may indicate complications
5. Failing to recognize EBV infection in immunocompromised patients, where it can lead to more severe outcomes 5, 1

Remember that infectious mononucleosis is generally a self-limited disease with an excellent prognosis when managed appropriately with supportive care.