Dexamethasone Oral Elixir for Infectious Mononucleosis
Dexamethasone oral elixir is NOT recommended as routine treatment for infectious mononucleosis, but may be considered only for specific severe complications such as respiratory compromise or severe pharyngeal edema. 1, 2
Evidence Against Routine Use
The evidence does not support routine corticosteroid use in infectious mononucleosis:
A Cochrane systematic review of 7 RCTs (362 participants) found insufficient evidence for steroid efficacy in symptom control, with no benefit demonstrated in 8 of 10 health improvement assessments 3
While two trials showed transient benefit for sore throat at 12 hours, this benefit was not maintained beyond the initial period 3
A pediatric trial specifically evaluating oral dexamethasone (0.3 mg/kg, maximum 15 mg) found only short-lived pain relief within the first 12 hours, with no sustained benefit at 24,48, or 72 hours compared to placebo 4
The short duration of effect suggests a single dose is insufficient and additional doses may be necessary, though this approach lacks supporting evidence 4
Limited Indications for Use
Corticosteroids should be reserved for specific severe complications:
- Respiratory compromise or impending airway obstruction 2
- Severe pharyngeal edema 2
- These represent emergency situations where anti-inflammatory effects may be life-saving 1
Safety Concerns
The risk-benefit profile is unfavorable for routine use:
- Adverse events documented include respiratory distress and acute onset of diabetes, though causality is uncertain 3
- There is insufficient research on side effects and long-term complications of steroid use in infectious mononucleosis 3
- The self-limited nature of the disease (typically 2-3 weeks) does not justify routine immunosuppression 1, 5
Recommended Management Approach
Standard supportive care remains the mainstay:
- Adequate hydration, analgesics, antipyretics, and rest guided by the patient's energy level 2
- Avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly persists to prevent splenic rupture (occurs in 0.1-0.5% of cases) 5
- Bed rest should not be enforced; activity should be self-directed 2