From the Guidelines
Infectious mononucleosis management should primarily focus on supportive care, as the condition is self-limiting and most patients recover completely within 2-4 weeks. The management approach should prioritize rest, adequate hydration, and nutrition. For symptom relief, medications such as acetaminophen or ibuprofen can be used to manage fever and pain 1.
Supportive Care
- Rest is essential until symptoms improve, typically for 2-4 weeks, with gradual return to normal activities as tolerated.
- Adequate hydration and nutrition should be maintained to support the body's recovery process.
- Acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) can be used for symptom relief.
Corticosteroids Use
- Severe throat pain may require short-term corticosteroids like prednisone (40-60 mg daily for 5-7 days with tapering), though this is reserved for cases with significant swelling affecting breathing or swallowing, as suggested by anecdotal reports of their use in neurologic complications of Epstein-Barr virus infection 1.
Prevention of Complications
- Contact sports and heavy lifting should be avoided for at least 3-4 weeks to prevent splenic rupture, as splenomegaly is common in infectious mononucleosis.
- Alcohol should be avoided during recovery due to potential liver involvement.
- Patients should be monitored for rare complications including severe throat swelling, extreme fatigue lasting beyond 1-2 months, or signs of splenic rupture (sudden left upper quadrant pain).
Antiviral Therapy
- Antiviral therapy with acyclovir is not recommended for the treatment of infectious mononucleosis, as it probably provides little or no benefit 1.
In real-life clinical practice, the focus should be on supportive care and monitoring for potential complications, rather than on antiviral therapy, which has not shown significant benefits in the management of infectious mononucleosis 1.
From the Research
Infectious Mononucleosis Management
Infectious mononucleosis, caused by Epstein-Barr virus (EBV), is a common illness among adolescents and young adults, characterized by fever, tonsillar pharyngitis, and lymphadenopathy 2. The management of infectious mononucleosis is mainly supportive, with a focus on relieving symptoms and preventing complications.
Diagnosis and Treatment
- The diagnosis of infectious mononucleosis is typically made using a combination of clinical presentation, laboratory tests, and physical examination 3.
- The heterophile antibody test is a commonly used diagnostic test, with a sensitivity of 87% and specificity of 91% 3.
- Treatment is mainly supportive, with rest, hydration, and symptomatic relief being the mainstays of management 2, 4.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective in quickly resolving symptoms associated with EBV-induced infectious mononucleosis, particularly in patients with atopic predispositions 5.
- Antiviral agents may be considered in patients with severe infectious mononucleosis or those with complications 6.
Complications and Prevention
- Splenic rupture is a rare but potentially life-threatening complication of infectious mononucleosis, and patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present 2.
- Immunosuppressed populations are at higher risk of severe disease and significant morbidity 3, 4.
- The development of an effective, safe, and affordable EBV vaccine is considered the most effective way to prevent EBV infection and infectious mononucleosis 2.
Return to Activity
- Patients with infectious mononucleosis should not participate in athletic activity for three weeks from onset of symptoms, and shared decision-making should be used to determine the timing of return to activity 3.