Treatment of Infectious Mononucleosis
Supportive care is the mainstay of treatment for infectious mononucleosis, with no role for antiviral therapy in otherwise healthy individuals. 1, 2
Primary Treatment Approach
Symptomatic Management
- Provide adequate hydration, analgesics for pain, and antipyretics for fever control 1, 2
- Activity should be guided by the patient's energy level rather than enforced bed rest 2
- Fatigue, myalgias, and need for sleep may persist for several months after acute infection resolves 2
Medications NOT Recommended for Routine Use
- Acyclovir does not ameliorate the course of infectious mononucleosis in otherwise healthy individuals and should not be used 1, 2
- Antihistamines are not recommended for routine treatment 2
- Corticosteroids are not recommended for routine treatment but should be reserved for specific severe complications 1, 2
Corticosteroid Use: When to Consider
Corticosteroids may be indicated only for severe complications including:
- Respiratory compromise or impending airway obstruction 1, 2
- Severe pharyngeal edema 2
- Severe neurologic complications 1
- Severe hematologic complications 1
- Severe cardiac complications 1
Activity Restrictions
Patients must be withdrawn from contact or collision sports for at least 4 weeks after symptom onset 2
- More conservative recommendations suggest avoiding contact sports or strenuous exercise for 8 weeks or while splenomegaly persists 3
- This restriction is critical to prevent splenic rupture, which occurs in 0.1-0.5% of cases and is potentially life-threatening 3, 4
Special Population: Immunocompromised Patients
For immunocompromised patients with primary EBV infection, management differs significantly:
- Reduce or discontinue immunomodulator therapy if possible 1
- Antiviral therapy with ganciclovir or foscarnet may be considered in severe cases, though evidence is limited 1
- These patients have increased risk of lymphoproliferative disorders and require careful monitoring 1
- Discontinuation of immunosuppressive therapy may result in spontaneous regression of EBV-associated lymphoproliferative disease 1
Common Pitfalls to Avoid
- Do not prescribe antibiotics empirically without ruling out streptococcal pharyngitis, as ampicillin/amoxicillin can cause a characteristic rash in 90% of patients with infectious mononucleosis 2
- Do not use acyclovir thinking it will shorten disease course—it provides no benefit 1, 2
- Do not allow return to contact sports before 4 weeks minimum, regardless of how well the patient feels 2
- Do not use corticosteroids routinely for symptom relief—reserve only for life-threatening complications 1, 2