From the Guidelines
Mono treatment should primarily focus on supportive care, as antiviral medications like acyclovir have not shown significant benefit in treating infectious mononucleosis 1. The management of mono involves a multifaceted approach to alleviate symptoms and prevent complications.
- Rest and hydration are crucial, with patients advised to get adequate rest for 2-4 weeks and stay well-hydrated with water and clear fluids.
- For symptom management, over-the-counter medications such as acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours can be used to relieve fever and sore throat pain 1.
- Warm salt water gargles (1/2 teaspoon salt in 8 ounces warm water) several times daily can also help with throat discomfort.
- It's essential to avoid contact sports and heavy lifting for at least 4 weeks or until cleared by a healthcare provider, as mono can cause spleen enlargement which increases the risk of rupture.
- Corticosteroids like prednisone may be prescribed for severe throat swelling but are not routine, and their use is generally reserved for specific cases, such as increased intracranial pressure or severe neurologic complications 1.
- Antibiotics are not effective against mono's viral cause and should be avoided unless there's a confirmed bacterial co-infection.
- Most patients recover completely within 2-4 weeks, though fatigue may persist longer in some cases.
From the Research
Treatment Options for Mono
- The primary treatment for infectious mononucleosis is supportive, focusing on reducing symptoms and managing complications 2, 3.
- Rest and avoidance of strenuous activities, such as contact sports, are recommended for patients with infectious mononucleosis to minimize the risk of splenic rupture 2, 3.
- Antiviral medications and corticosteroids are not routinely recommended for the treatment of infectious mononucleosis, except in cases of severe complications 3, 4, 5.
Symptom Management
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective in quickly resolving symptoms associated with EBV-induced infectious mononucleosis, particularly in patients with atopic predispositions 6.
- Steroids have been used for symptom control in infectious mononucleosis, but there is insufficient evidence to support their efficacy, and their use is not universally recommended 4, 5.
- The use of steroids may be beneficial in reducing sore throat and fatigue in some cases, but the evidence is limited and inconsistent 4, 5.
Considerations for Specific Patient Populations
- Immunosuppressed patients are at higher risk of severe disease and significant morbidity from infectious mononucleosis 3.
- Patients with atopic predispositions may benefit from the use of NSAIDs for symptom management 6.
- The risk of splenic rupture and other complications should be carefully considered when managing patients with infectious mononucleosis, particularly those with a history of splenomegaly or other underlying medical conditions 2, 3.