Treatment of Infectious Mononucleosis
Treatment of infectious mononucleosis in adolescents and young adults is primarily supportive care, with antivirals and corticosteroids reserved only for specific severe complications or immunocompromised patients. 1, 2
Supportive Care (Mainstay of Treatment)
Supportive management is the cornerstone of treatment for otherwise healthy patients with infectious mononucleosis. 1, 2
- Antipyretics for fever control (acetaminophen or ibuprofen) 2
- Adequate analgesia for pharyngeal pain 3
- Rest as tolerated with reduction of activity 4
- Avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly persists, due to risk of splenic rupture (occurs in 0.1-0.5% of cases) 4, 5
Antiviral Therapy (Not Recommended for Routine Use)
Acyclovir and other antiviral agents have no proven benefit in treating infectious mononucleosis in otherwise healthy individuals and are not recommended for routine use. 1, 2
- Antiviral therapy with ganciclovir or foscarnet may be considered only in severe primary EBV infection in immunosuppressed patients, despite lack of strong supporting evidence 1, 2
Corticosteroid Therapy (Limited Indications)
Corticosteroids are not recommended for routine treatment but may be beneficial only in specific severe complications. 1, 2
Specific indications for corticosteroids:
- Severe airway obstruction or pharyngeal edema requiring intervention 1, 3
- Severe neurologic complications 2, 3
- Severe hematologic complications (e.g., thrombocytopenic purpura) 2, 3
- Cardiac complications 2
Critical Medication Pitfall to Avoid
Avoid empirical antibiotic prescription without confirming bacterial superinfection, as antibiotics (particularly ampicillin/amoxicillin) may cause a characteristic rash in patients with infectious mononucleosis 1
Special Management for Immunocompromised Patients
Immunosuppressed patients require specialist consultation and modified management. 1, 2
- Reduce or discontinue immunomodulator therapy if possible when primary EBV infection occurs 1, 2
- In patients on thiopurine therapy, careful clinical assessment with full blood count, blood film, liver function tests, and EBV serology is warranted 1
- Discontinuation of immunosuppressive therapy may result in spontaneous regression of EBV-associated lymphoproliferative disease 2
- For EBV-seronegative adolescents requiring immunosuppression, consider alternative immunomodulators to thiopurines to prevent primary EBV infection, which carries risk of hemophagocytic lymphohistiocytosis (HLH) 6
Management of Symptomatic Infectious Mononucleosis
In immunosuppressed IBD patients with symptomatic infectious mononucleosis, immunosuppressive therapy should be discontinued. 7