What is the treatment for infectious mononucleosis (mono)?

Treatment of Infectious Mononucleosis (Mono)

Supportive care is the mainstay of treatment for infectious mononucleosis, as there is no specific antiviral therapy that has been proven effective for routine management of this condition. 1, 2

Diagnostic Confirmation

Before initiating treatment, confirm the diagnosis with:

• Heterophile antibody test (Monospot) - becomes positive between 6-10 days after symptom onset 3
• If clinical suspicion remains high despite negative Monospot, obtain EBV serologic testing:
  • VCA IgM antibodies (with or without VCA IgG) without EBNA antibodies indicates recent primary infection 3, 1
  • False-negative heterophile results are common early in infection and in children under 10 years 1

First-Line Treatment Approach

Supportive Care

• Adequate hydration and antipyretics for fever management 1, 2
• Analgesics for pain relief, particularly for sore throat 2
• Allow for adequate rest guided by the patient's energy level (do not enforce strict bed rest) 2, 4
• Patients should be allowed out of bed as soon as they feel able, as this approach has been shown to result in quicker recovery compared to imposed bed rest 4

Activity Restrictions

• Avoid contact sports or strenuous exercise for at least 8 weeks or while splenomegaly is present 5, 6
• Withdraw from collision sports for at least 4 weeks after symptom onset to reduce risk of splenic rupture 2, 6
• Spontaneous splenic rupture occurs in 0.1-0.5% of patients and is potentially life-threatening 5

Medications to Avoid in Routine Cases

• Corticosteroids are not recommended for routine treatment of infectious mononucleosis 1, 2

• Reserve corticosteroids only for severe complications such as:

  • Impending airway obstruction due to severe pharyngeal edema 1, 7
  • Severe hematologic complications 7
  • Significant neurologic complications 1

• Prolonged steroid use in uncomplicated cases may lead to serious complications including sepsis 7

• Acyclovir is not recommended as it does not improve outcomes in otherwise healthy individuals 1, 2

• Antihistamines are not recommended for routine treatment 2

Special Considerations

Immunocompromised Patients

• Consider reducing or discontinuing immunomodulator therapy if possible 1
• Antiviral agents (ganciclovir or foscarnet) may be considered in severe cases despite limited supporting evidence 1
• These patients require careful monitoring due to increased risk of lymphoproliferative disorders 1

Prolonged Symptoms

• Fatigue, myalgias, and increased need for sleep may persist for several months after the acute infection 2
• Infectious mononucleosis is a risk factor for chronic fatigue syndrome 5
• Poor physical functioning and lengthy convalescence are predictors of prolonged illness 4

Monitoring and Follow-up

• Monitor for potential complications, particularly in the first month after diagnosis when risk of splenic rupture is highest 6
• No specific laboratory monitoring is required in uncomplicated cases
• Consider follow-up evaluation if symptoms persist beyond 3 months 5