What is the treatment for infectious mononucleosis (mono)?

Treatment of Infectious Mononucleosis (Mono)

The treatment for infectious mononucleosis is primarily supportive care, as it is a self-limited viral illness with no specific antiviral therapy recommended for routine treatment. 1, 2

Diagnosis

Before initiating treatment, confirm the diagnosis with:

• Clinical presentation: Triad of fever, tonsillar pharyngitis, and lymphadenopathy (particularly posterior cervical) in patients 10-30 years of age 1, 2
• Laboratory findings: Atypical lymphocytosis (>10% of total lymphocyte count) and positive heterophile antibody test (Monospot) 2, 3
• If Monospot is negative but clinical suspicion remains high, consider EBV-specific serologic testing for viral capsid antigens 4

Supportive Care

1. Hydration and Rest

   • Ensure adequate hydration 1
   • Allow activity as tolerated based on the patient's energy level (do not enforce strict bed rest) 1, 2
   • Fatigue may persist for several months after acute infection 2

2. Symptom Management

   • Analgesics and antipyretics for pain and fever control 1
   • Throat lozenges or warm salt water gargles for pharyngitis symptoms 2

Activity Restrictions

• Avoid contact or collision sports for at least 4-8 weeks after symptom onset or while splenomegaly is present 1, 3
• This restriction is critical due to the risk of splenic rupture, which occurs in 0.1-0.5% of cases and is potentially life-threatening 2, 4

Medications NOT Routinely Recommended

• Corticosteroids are not recommended for routine treatment 1
  • Exception: May be considered for patients with severe pharyngeal edema or respiratory compromise 1
• Acyclovir or other antivirals are not recommended for routine treatment 1
• Antihistamines are not recommended for routine treatment 1

Monitoring and Follow-up

• Monitor for resolution of symptoms, which typically occurs within 2-4 weeks 2
• Be aware that fatigue may persist for several months 1, 2
• Consider follow-up physical examination to assess for resolution of splenomegaly before clearing for return to contact sports 3

Complications to Watch For

• Splenic rupture (most feared complication) 2, 4
• Respiratory compromise from severe pharyngeal edema 1
• Hepatitis (occurs in approximately 10% of cases) 5
• Neurologic complications (rare) 4
• Hematologic complications (rare) 4
• Chronic fatigue syndrome (infectious mononucleosis is a risk factor) 2

Special Considerations

• Adolescents and young adults (15-24 years) are most commonly affected 2
• EBV is transmitted primarily through saliva ("kissing disease") 3, 5
• Most patients have an uneventful recovery with supportive care alone 2

Remember that infectious mononucleosis is generally a benign, self-limited disease that requires supportive care rather than specific antiviral therapy 2, 4.