Treatment of Infectious Mononucleosis in a Preteenager
Treatment for infectious mononucleosis in a preteenager without complications is entirely supportive—no antivirals, no routine corticosteroids, just symptom management and activity restriction. 1, 2
Supportive Care Measures
- Rest and activity modification are the cornerstones of management, with bed rest as tolerated during the acute phase 1
- Hydration and nutrition should be maintained, though no specific dietary restrictions are necessary beyond what the child can tolerate 1
- Analgesics and antipyretics such as acetaminophen or ibuprofen can be used for fever, sore throat, and general discomfort 1, 2
- Avoid aspirin in children due to the risk of Reye syndrome 1
Activity Restrictions
- Complete avoidance of contact sports and strenuous exercise for 8 weeks from symptom onset or until splenomegaly resolves, whichever is longer 1
- This restriction is critical because splenic rupture occurs in 0.1-0.5% of cases and is potentially life-threatening 1
- Shared decision-making can be used to determine exact timing of return to activity, but the 3-week minimum from symptom onset is the current guideline recommendation 2
What NOT to Do
- Do not routinely prescribe corticosteroids for uncomplicated infectious mononucleosis—they are reserved only for impending airway obstruction or severe hematological complications 3, 2
- Prolonged steroid use in uncomplicated cases has been associated with severe complications including septic shock, polymicrobial bacteremia, and multiple infectious complications 3
- Do not prescribe antivirals as routine treatment—there is no evidence supporting their use in uncomplicated cases 2
- Avoid prescribing antibiotics such as amoxicillin or ampicillin, as they cause a characteristic maculopapular rash in 90% of patients with infectious mononucleosis 1
Monitoring and Follow-up
- Monitor for complications including splenic rupture (abdominal pain, left shoulder pain), airway obstruction (severe tonsillar enlargement), and severe hepatitis 1, 2
- Most patients recover uneventfully within 2-4 weeks, though fatigue may persist for up to 3 months 1
- No routine laboratory monitoring is needed in uncomplicated cases once the diagnosis is established 2
When to Escalate Care
- Severe tonsillar enlargement threatening airway patency requires immediate evaluation and is the primary indication for corticosteroid therapy 3, 2
- Severe abdominal pain requires urgent evaluation for possible splenic rupture 1
- Severe hematological complications (profound thrombocytopenia, hemolytic anemia) may warrant corticosteroid therapy 3
- Persistent high fever beyond 2 weeks or clinical deterioration should prompt re-evaluation for secondary bacterial infection or other complications 1