What are the recommended treatments and management strategies for mononucleosis recovery?

Management of Infectious Mononucleosis Recovery

Treatment of infectious mononucleosis is primarily supportive, focusing on adequate hydration, analgesics, antipyretics, and activity modification guided by the patient's energy level, with most patients experiencing complete resolution within 2-3 weeks though fatigue may persist for several months. 1, 2, 3

Immediate Supportive Care

• Hydration and symptom management are the cornerstones of treatment, including analgesics for throat pain and fever control with antipyretics 2, 3
• Activity should be self-paced based on the patient's energy level rather than enforcing strict bed rest, as forced bed rest is not recommended 2
• Adequate rest is essential, but patients should remain as active as their symptoms allow 1, 2

Medications NOT Routinely Recommended

• Corticosteroids are NOT recommended for routine treatment of uncomplicated infectious mononucleosis 2, 4, 3
• Corticosteroids may be considered only for specific severe complications including respiratory compromise or severe pharyngeal edema that threatens airway patency 2
• Antivirals (acyclovir) are NOT recommended for routine management 2, 4
• Antihistamines are NOT recommended for routine treatment 2

Activity Restrictions and Return to Sports

Patients must avoid contact sports and strenuous exercise for a minimum of 3 weeks from symptom onset, with some guidelines recommending 4-8 weeks or until splenomegaly resolves. 1, 2, 4, 3

• The 3-week restriction is the current guideline recommendation from onset of symptoms, though this should involve shared decision-making with the patient 4, 3
• Alternative recommendation of 4 weeks minimum for withdrawal from contact or collision sports exists in some guidelines 2
• 8-week restriction or continuation until splenomegaly resolves may be more conservative and appropriate for high-risk activities 1
• The primary concern is splenic rupture, which occurs in 0.1-0.5% of patients and is potentially life-threatening, typically within the first month of symptom onset 1, 4

Expected Recovery Timeline

• Acute symptoms (fever, pharyngitis, lymphadenopathy) typically resolve within 2-3 weeks 2, 5
• Fatigue, myalgias, and increased sleep requirements may persist for several months after acute infection resolves 2
• Profound fatigue tends to resolve within 3 months in most patients 1
• Infectious mononucleosis is a risk factor for chronic fatigue syndrome in some patients 1

Monitoring for Complications

• Splenomegaly occurs in approximately 50% of cases and requires activity restriction 1
• Hepatomegaly occurs in approximately 10% of cases 1
• Patients should be monitored for signs of splenic rupture including sudden onset of severe left upper quadrant or left shoulder pain 1, 4
• Respiratory compromise or severe pharyngeal edema are indications for possible corticosteroid use 2

Common Pitfalls to Avoid

• Do not enforce strict bed rest; allow patient-guided activity levels 2
• Do not use corticosteroids, antivirals, or antihistamines routinely 2, 4, 3
• Do not allow return to contact sports or strenuous activity before the minimum 3-week period 4, 3
• Do not dismiss persistent fatigue as abnormal; counsel patients that fatigue lasting several months is expected 2
• Do not overlook the need for shared decision-making regarding return to athletic activity 4, 3