Treatment for Suspected Infectious Mononucleosis
Treatment for suspected infectious mononucleosis is primarily supportive, focusing on adequate hydration, analgesics, antipyretics, and rest guided by the patient's energy level rather than enforced bed rest. 1
Initial Management Approach
Symptomatic Treatment (Mainstay of Care)
- Hydration: Ensure adequate fluid intake to prevent dehydration 1
- Analgesics and antipyretics: Use acetaminophen or NSAIDs for fever and throat pain management 1
- Activity modification: Allow patients to self-regulate activity based on energy levels rather than mandating strict bed rest 1
- Rest: Adequate rest is important, but enforced bed rest is not recommended 1
What NOT to Routinely Use
- Corticosteroids are NOT recommended for routine treatment of infectious mononucleosis 1
- Exception: May benefit patients with respiratory compromise or severe pharyngeal edema 1
- Acyclovir is NOT recommended for routine management 1
- Antihistamines are NOT recommended for routine treatment 1
Critical Safety Measures
Activity Restrictions
Patients must be withdrawn from contact or collision sports for at least 4 weeks after symptom onset to prevent splenic rupture 1. More recent evidence suggests extending this to 8 weeks or until splenomegaly resolves 2.
- Splenic rupture occurs in 0.1-0.5% of patients and is potentially life-threatening 2
- Patients should avoid strenuous exercise during this period 2
- Splenomegaly occurs in approximately 50% of cases 2
Expected Clinical Course
- Acute symptoms (fever, pharyngitis, lymphadenopathy) typically resolve within a few weeks 1, 2
- Fatigue, myalgias, and need for sleep may persist for several months after acute infection resolves 1
- Most patients have an uneventful recovery 2
- Infectious mononucleosis is a risk factor for chronic fatigue syndrome 2
When to Consider Corticosteroids
Corticosteroids should be reserved for specific complications:
- Respiratory compromise (airway obstruction from tonsillar enlargement) 1
- Severe pharyngeal edema threatening airway patency 1
Common Pitfalls to Avoid
- Do not prescribe ampicillin or amoxicillin if streptococcal pharyngitis has not been confirmed, as these cause a characteristic rash in 90% of mononucleosis patients 1
- Do not allow return to contact sports before 4-8 weeks, even if patient feels better 1, 2
- Do not dismiss persistent fatigue as malingering—it can legitimately persist for months 1