Treatment of Infectious Mononucleosis
Treatment for infectious mononucleosis is entirely supportive, as aciclovir does not ameliorate the course of the disease in otherwise healthy individuals. 1
Supportive Care Measures
The mainstay of management consists of:
- Adequate hydration, analgesics, and antipyretics for symptom relief 2
- Activity modification guided by the patient's energy level rather than enforced bed rest 2
- Rest as tolerated with gradual return to normal activities 3
- Avoidance of contact or collision sports for at least 4 weeks (some sources recommend 8 weeks) after symptom onset or while splenomegaly persists 3, 2
Role of Corticosteroids
Corticosteroids should be reserved exclusively for airway obstruction or severe pharyngeal edema causing respiratory compromise. 1
The evidence does not support routine corticosteroid use:
- Insufficient evidence exists for steroid efficacy in symptom control for uncomplicated infectious mononucleosis 4
- Across multiple trials, no sustained benefit was found in 8 of 10 assessments of health improvement with steroid therapy 4
- While two trials showed reduced sore throat at 12 hours with steroids, this benefit was not maintained beyond the initial period 4
- Serious complications have been documented with prolonged steroid use, including polymicrobial bacteremia, septic shock, pulmonary septic emboli, and orbital cellulitis 5
- Adverse events reported include respiratory distress and acute onset of diabetes, though causality is uncertain 4
Antiviral Therapy
Aciclovir is not recommended as it does not improve clinical outcomes in immunocompetent patients with infectious mononucleosis 1
Management in Special Populations
For immunocompromised patients:
- Reduce or discontinue immunomodulator therapy if possible when primary EBV infection is suspected 1
- Obtain complete blood count, blood film, and liver function tests in patients on immunosuppressive therapy 1
- Specialist consultation is required due to increased risk of EBV-associated lymphoproliferative disease 1
Expected Clinical Course
- Most patients have an uneventful recovery with spontaneous resolution 3
- Fatigue may persist for several months after acute infection resolves, but typically improves within three months 3, 2
- Spontaneous splenic rupture occurs in 0.1 to 0.5% of cases and represents the most feared complication 3, 6
Prevention Measures
- Avoid sharing personal items contaminated with saliva and practice hand hygiene during outbreaks in close community settings 1