What is the treatment for infectious mononucleosis?

Treatment of Infectious Mononucleosis

Supportive care is the mainstay of treatment for infectious mononucleosis, including adequate hydration, analgesics, antipyretics, and rest as tolerated. 1, 2

General Management Principles

• Infectious mononucleosis is a self-limited disease caused by Epstein-Barr virus (EBV) that typically resolves without specific antiviral treatment 3
• Activity should be guided by the patient's energy level rather than enforced bed rest 2
• Adequate hydration and antipyretics for fever management are essential components of supportive care 1
• Patients should avoid contact sports or strenuous exercise for at least 8 weeks or while splenomegaly is present to prevent splenic rupture 3, 2

Medication Considerations

• Corticosteroids are not recommended for routine treatment of infectious mononucleosis 1, 2
• Corticosteroids should be reserved for specific complications such as:
  • Impending airway obstruction due to severe tonsillar hypertrophy 1
  • Severe neurologic complications 1
  • Significant hematologic complications (e.g., hemolytic anemia, thrombocytopenia) 1
  • Cardiac complications 1
• Prolonged steroid therapy for uncomplicated infectious mononucleosis may lead to severe complications including sepsis and should be avoided 4
• Acyclovir and other antiviral agents are not recommended for routine treatment in immunocompetent individuals 1, 2
• Antiviral therapy (ganciclovir or foscarnet) may be considered in severe cases in immunocompromised patients 1

Management of Specific Symptoms

• Sore throat: Analgesics, warm salt water gargles, and adequate hydration 2
• Fever: Acetaminophen or NSAIDs as needed 1
• Fatigue: Rest as needed, with gradual return to normal activities as symptoms improve 2
• Lymphadenopathy: Usually resolves without specific treatment; warm compresses may provide comfort 3

Monitoring and Follow-up

• Monitor for potential complications, particularly splenic rupture (occurs in 0.1-0.5% of cases) 3
• Patients should be advised about the potential for prolonged fatigue, which may persist for several months after the acute infection has resolved 2
• Follow-up is recommended to ensure resolution of symptoms and to monitor for complications 3

Special Considerations

• Immunocompromised patients require closer monitoring due to increased risk of lymphoproliferative disorders 1
• If a patient is on immunomodulator therapy, consider reducing or discontinuing it if possible during acute EBV infection 1
• False-negative heterophile antibody tests are common early in the course of infection, so clinical judgment should guide management decisions when diagnostic uncertainty exists 5, 1

Common Pitfalls to Avoid

• Prescribing corticosteroids for routine symptom management in uncomplicated cases 4
• Enforcing strict bed rest rather than allowing activity as tolerated 2
• Allowing return to contact sports too early (before 8 weeks or while splenomegaly persists) 3
• Failing to consider alternative diagnoses in patients with mononucleosis-like illness and negative heterophile antibody tests 5