From the Guidelines
Treatment for mononucleosis should primarily focus on supportive care, as it is a viral infection that typically resolves on its own, with rest, hydration, and pain management being key components, as there is no clear benefit from antiviral medications like acyclovir in the treatment of infectious mononucleosis 1. The management of mononucleosis involves a multifaceted approach to alleviate symptoms and prevent complications. Key aspects include:
- Rest: Essential for recovery, often for several weeks, as fatigue can persist
- Pain and fever management: Acetaminophen or ibuprofen can be used for relief
- Hydration and nutrition: Maintaining good hydration and nutrition is crucial for recovery
- Avoiding strenuous activities: Contact sports and strenuous activities should be avoided for at least 4 weeks or until the doctor clears the patient, due to the risk of splenic rupture
- Monitoring for complications: Follow-up visits are necessary to check for resolution of symptoms and to assess spleen size Corticosteroids like prednisone may be prescribed in severe cases with significant throat swelling or breathing difficulties, as they have been reported to be helpful in selected patients with neurologic complications of Epstein-Barr virus infection 1. It is also important to note that antibiotics are not effective against the Epstein-Barr virus but may be prescribed if a secondary bacterial infection develops. Follow-up care should include a visit 2-4 weeks after diagnosis to assess the resolution of symptoms and spleen size, with most patients recovering completely within 2-4 months, though fatigue may linger 1. Return to normal activities should be gradual, and alcohol should be avoided for at least 6 months as the liver may be affected. If symptoms worsen or new symptoms develop, such as severe abdominal pain, immediate medical attention should be sought, as this could indicate complications.
From the Research
Treatment for Mononucleosis
- The treatment for mononucleosis is mainly supportive, with a focus on reducing symptoms and managing complications 2, 3.
- Rest and avoidance of strenuous activities are recommended, with patients advised to avoid contact sports or exercise for 8 weeks or while splenomegaly is still present 2.
- There is no evidence to support the routine use of antivirals or corticosteroids in the treatment of mononucleosis, although corticosteroids may be used in certain cases, such as impending airway obstruction 3, 4.
- Symptom relief and rest are commonly recommended treatments, with patients often experiencing spontaneous recovery within a few weeks 5, 4.
Follow-up and Monitoring
- Patients with mononucleosis should be monitored for potential complications, such as splenic rupture, which can be life-threatening 2, 3.
- Follow-up appointments with a healthcare provider are recommended to assess for resolution of symptoms and to monitor for any potential complications 2, 3.
- Patients should be advised to seek medical attention immediately if they experience any severe symptoms, such as severe abdominal pain or difficulty breathing 2, 3.
Use of Corticosteroids
- The use of corticosteroids in the treatment of mononucleosis is not universally recommended, with some studies suggesting that they may not provide significant benefits in terms of symptom relief 4, 6.
- However, corticosteroids may be used in certain cases, such as impending airway obstruction, or in patients with severe symptoms or complications 3, 4.
- The decision to use corticosteroids should be made on a case-by-case basis, taking into account the individual patient's symptoms and medical history 4, 6.