What is the recommended treatment for infectious mononucleosis (mono)?

Treatment for Infectious Mononucleosis (Mono)

Supportive care is the mainstay of treatment for infectious mononucleosis, as there is no specific antiviral therapy recommended for routine management of this self-limiting condition. 1, 2

Recommended Treatment Approach

Supportive Care

• Adequate hydration to prevent dehydration, especially if fever is present 1
• Analgesics and antipyretics (such as acetaminophen or NSAIDs) for pain relief and fever control 1, 3
• Adequate rest guided by the patient's energy level - bed rest should not be enforced 1
• Throat lozenges or salt water gargles for symptomatic relief of pharyngitis 3

Activity Restrictions

• Avoid contact sports or strenuous exercise for at least 3-4 weeks from symptom onset 3
• Continue activity restrictions for up to 8 weeks or until splenomegaly resolves to prevent risk of splenic rupture 2
• Consider ultrasound evaluation at 1 month after diagnosis to assess splenic size before return to contact sports 4

Medications NOT Routinely Recommended

• Corticosteroids are not recommended for routine treatment of infectious mononucleosis 1, 3
  • Exception: Consider corticosteroids only for patients with severe complications such as:
    • Significant airway obstruction
    • Severe pharyngeal edema
    • Respiratory compromise 1, 5
• Antiviral medications (such as acyclovir) are not recommended for routine treatment 1, 3
• Antihistamines are not recommended for routine treatment 1

Monitoring and Follow-up

• Clinical review should be arranged for patients with persistent symptoms 1
• Most patients recover completely within 2-3 weeks, though fatigue may persist for several months 2, 3
• Monitor for potential complications:
  • Splenic rupture (occurs in 0.1-0.5% of cases) 2
  • Hepatitis with elevated liver enzymes 3
  • Airway obstruction due to tonsillar hypertrophy 3
  • Neurological complications (rare) 2

Special Considerations

• Immunocompromised patients are at higher risk for severe disease and complications 3
• Patients with negative heterophile antibody tests but classic symptoms may need EBV-specific serologic testing (viral capsid antigen antibodies) 3
• Patients should be advised that transmission occurs primarily through saliva, though specific isolation precautions are generally not required 2

Common Pitfalls to Avoid

• Prescribing antibiotics for pharyngitis without ruling out streptococcal infection 3
• Allowing premature return to contact sports before splenic enlargement has resolved 4
• Using corticosteroids routinely for symptom management when evidence does not support this practice 5
• Enforcing strict bed rest, which is unnecessary and may prolong recovery 1