From the Guidelines
Infectious mononucleosis treatment primarily focuses on managing symptoms while the body fights the Epstein-Barr virus infection, with rest, hydration, and symptom relief being the cornerstone of treatment. The most recent and highest quality study 1 suggests that aciclovir therapy does not ameliorate the course of infectious mononucleosis in otherwise healthy individuals.
Treatment Approach
- Rest is essential, with patients needing adequate sleep and reduced physical activity for several weeks until symptoms improve.
- For symptom relief, acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours can help manage fever and pain.
- Gargling with warm salt water (1/2 teaspoon salt in 8 ounces of water) several times daily can soothe sore throat discomfort.
- Staying hydrated is crucial, aiming for at least 8-10 glasses of water daily.
- Patients should avoid contact sports and heavy lifting for at least 4 weeks to prevent splenic rupture, as the spleen often enlarges during infection.
- Alcohol should be avoided completely while recovering and for several months afterward to prevent liver strain.
- Corticosteroids like prednisone may be prescribed in severe cases with significant throat swelling, but aren't routinely recommended, as stated in 1 and 1.
- Antibiotics aren't effective against viral infections like mono, though they might be prescribed if a secondary bacterial infection develops.
Key Considerations
- Most patients recover completely within 2-4 weeks, though fatigue may persist for several months in some cases.
- The use of antiviral agents has no proven role in the treatment of established infectious mononucleosis, as noted in 1.
- Steroid therapy may be indicated for airway obstruction, as mentioned in 1.
From the Research
Treatment Overview
The treatment for infectious mononucleosis is mainly supportive, focusing on relieving symptoms and managing complications 2.
Supportive Care
- Reduction of activity and bed rest as tolerated are recommended 2.
- Patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2.
Pharmacological Interventions
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may quickly resolve symptoms associated with EBV-induced infectious mononucleosis, particularly in patients with atopic predispositions 3.
- Antiviral agents, such as acyclovir, valomaciclovir, and valacyclovir, may be effective in treating infectious mononucleosis, although the quality of evidence is very low and their use is controversial 4, 5, 6.
- Corticosteroids are the mainstay of treatment for complications, and antivirals may be used as an adjunct to steroid treatment in severe cases 5.
Management of Complications
- Splenic rupture is a potentially life-threatening complication, and prompt diagnosis is essential to avoid unnecessary investigations and treatments and to minimize complications 2.
- Antiviral treatment may be considered in severe manifestations of EBV infections in immunocompetent patients, such as CNS involvement, peripheral nervous system involvement, hepatitis, and other afflictions 5.