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

Treatment for 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, 2

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis with:

• Clinical presentation: Sore throat, significant fatigue, fever, posterior cervical lymphadenopathy
• Laboratory findings:
  • Atypical lymphocytosis ≥20% or atypical lymphocytosis ≥10% plus lymphocytosis ≥50%
  • Positive heterophile antibody test (Monospot)
  • If Monospot negative, EBV-specific serology (VCA IgM, VCA IgG, EBNA IgG) 1, 3

Supportive Care Treatment Algorithm

1. Rest and Activity Management:

   • Adequate rest based on patient's energy level
   • No enforced bed rest
   • Avoid contact or collision sports for at least 8 weeks or while splenomegaly is present 1, 2

2. Symptomatic Relief:

   • Adequate hydration
   • Analgesics for pain (acetaminophen or NSAIDs)
   • Antipyretics for fever
   • Warm salt water gargles for sore throat 3, 2

3. Monitoring for Complications:

   • Assess for splenomegaly (occurs in ~50% of cases)
   • Watch for signs of airway obstruction
   • Monitor liver function (hepatomegaly occurs in ~10% of cases) 2

Special Considerations

Corticosteroids

• Not recommended for routine treatment of infectious mononucleosis
• Only indicated for:
  • Impending airway obstruction
  • Severe pharyngeal edema
  • Hematological complications 1, 3, 4

Antiviral Therapy

• Acyclovir is not recommended for routine treatment
• May be considered in severe or persistent cases of chronic active EBV infection 1, 3

Duration of Illness

• Most symptoms resolve within 2-4 weeks
• Fatigue may persist for several months after acute infection 3, 2

Common Pitfalls to Avoid

1. Inappropriate Corticosteroid Use:

   • Prolonged steroid therapy can lead to severe complications including sepsis and immunosuppression 4

2. Premature Return to Contact Sports:

   • Risk of splenic rupture (occurs in 0.1-0.5% of cases)
   • Can be life-threatening 2

3. Overreliance on Heterophile Antibody Tests Early in Disease:

   • False-negative results are common early in infection
   • Consider EBV-specific serology if clinical suspicion is high despite negative Monospot 1, 3

4. Unnecessary Antibiotic Prescription:

   • Antibiotics are not effective against viral infections
   • Amoxicillin can cause a characteristic rash in EBV infection 2

Patient Education

• Explain the self-limited nature of the illness
• Emphasize the importance of avoiding contact sports
• Discuss potential for prolonged fatigue
• Advise on avoiding sharing utensils, glasses, toothbrushes, or food
• Recommend covering coughs and sneezes and frequent handwashing 1

The evidence strongly supports that infectious mononucleosis is generally a benign, self-limited disease that primarily requires supportive care rather than specific antiviral or immunomodulatory treatment.