What is the treatment of choice for infectious mononucleosis?

From the Guidelines

Infectious mononucleosis is typically treated with supportive care, as there is no specific antiviral treatment recommended.

Treatment Overview

• The treatment of choice is focused on alleviating symptoms, such as fever, sore throat, and fatigue, rather than targeting the underlying viral infection.
• Corticosteroids may be used in certain cases, such as airway obstruction or severe neurological complications, as they have been reported to be helpful in anecdotal reports 1.
• Antiviral agents, such as acyclovir, have not been shown to provide significant benefit in the treatment of infectious mononucleosis 1.

Specific Considerations

• Immunosuppressive therapy should be discontinued in cases of symptomatic infectious mononucleosis, as it may exacerbate the condition 1.
• Supportive care measures, such as rest, hydration, and pain management, are essential in managing the symptoms of infectious mononucleosis.
• Monitoring for potential complications, such as airway obstruction or neurological involvement, is crucial in patients with infectious mononucleosis.

From the Research

Treatment of Infectious Mononucleosis

The treatment of infectious mononucleosis is mainly supportive, with a focus on managing symptoms and preventing complications. Key aspects of treatment include:

• Reduction of activity and bed rest as tolerated 2
• Avoiding contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2
• Symptomatic treatment, as there is no generally effective specific therapy 3
• Management of symptoms, such as fever, pharyngitis, and cervical lymphadenopathy 4

Role of Antiviral Agents

The use of antiviral agents in the treatment of infectious mononucleosis is controversial, with some studies suggesting potential benefits in certain cases:

• Antivirals, such as acyclovir and valacyclovir, may have a role in the treatment of infectious mononucleosis with complications 5
• A review of randomized controlled trials found that antiviral agents may reduce the time to clinical recovery and duration of lymphadenopathy, but the quality of evidence is very low 6

Prevention and Complications

Prevention of infectious mononucleosis is challenging, as avoiding exposure to EBV is almost impossible:

• The development of an effective, safe, and affordable EBV vaccine is considered the most effective way to prevent EBV infection and infectious mononucleosis 2
• Complications, such as splenic rupture, can be potentially life-threatening, and prompt diagnosis is essential to minimize risks 2, 4