Treatment of Infectious Mononucleosis
Treatment for infectious mononucleosis is primarily supportive care, as antiviral medications like acyclovir have no proven benefit in otherwise healthy individuals. 1, 2
Pharmacological Management
Antiviral Therapy
- Acyclovir and other antiviral agents are not recommended for routine treatment of infectious mononucleosis in immunocompetent patients, as they do not ameliorate the clinical course 3, 1, 4
- In immunosuppressed patients with severe primary EBV infection, ganciclovir or foscarnet may be considered despite lack of supporting evidence, though these agents are more toxic than acyclovir 3, 1
Corticosteroid Therapy
- Corticosteroids should be reserved only for specific severe complications, particularly severe airway obstruction or pharyngeal edema requiring intervention 1, 2
- Corticosteroids are not recommended for routine use and should be avoided unless benefits clearly outweigh potential risks 4, 2
Antibiotics
- Avoid empirical antibiotic prescription without confirming bacterial superinfection 1
- Ampicillin and amoxicillin should be specifically avoided, as they cause a characteristic rash in patients with infectious mononucleosis 1
Supportive Care Measures
Activity Modification
- Bed rest should not be enforced; the patient's energy level should guide activity 2
- Patients must avoid contact sports or strenuous exercise for at least 4 weeks after symptom onset to prevent splenic rupture 2
- Some sources recommend extending this restriction to 8 weeks or until splenomegaly resolves 5
Symptomatic Treatment
- Adequate hydration, analgesics, and antipyretics are the mainstays of supportive care 2
- Antihistamines are not recommended for routine treatment 2
Management in Special Populations
Immunosuppressed Patients
- Immunomodulator therapy should be reduced or discontinued if possible when primary EBV infection occurs in patients on immunosuppressive medications 3, 1
- Specialist consultation is essential for investigation and management of immunocompromised patients with primary EBV infection 1
- Careful clinical assessment is warranted with full blood count, blood film, liver function tests, and EBV serology for patients on thiopurine therapy 1
Severe Complications Requiring Intervention
- Discontinuation of immunosuppressive therapy may result in spontaneous regression of EBV-associated lymphoproliferative disease 3
- Biopsy diagnosis by a specialist hematopathologist is required to differentiate infectious mononucleosis from lymphoproliferative disease or lymphoma 3
Common Pitfalls and Caveats
- Fatigue, myalgias, and need for sleep may persist for several months after acute infection resolves 2
- Splenic rupture occurs in 0.1 to 0.5% of patients and is potentially life-threatening, making activity restriction critical 5
- Most cases are mild to moderate in severity with full recovery over several weeks, though more severe cases occasionally require hospital admission 4