Treatment of Sore Throat and Fatigue in Infectious Mononucleosis
The best treatment for infectious mononucleosis is supportive care with ibuprofen or paracetamol for symptom relief, activity restriction for 8 weeks to prevent splenic rupture, and avoidance of corticosteroids in uncomplicated cases. 1, 2
Symptomatic Management
- Use ibuprofen or paracetamol as first-line analgesics for sore throat pain, with ibuprofen showing slightly better efficacy for pain relief 3
- Both medications are safe for short-term use and should be dosed according to standard directions 4, 3
- Ensure adequate hydration and allow the patient's energy level to guide activity—do not enforce strict bed rest 2
- Fatigue typically resolves within 3 months, though it may persist longer in some patients 1, 2
Activity Restriction to Prevent Splenic Rupture
- Patients must avoid contact sports and strenuous exercise for 8 weeks from symptom onset or until splenomegaly resolves, whichever is longer 1
- Splenic rupture occurs in 0.1-0.5% of infectious mononucleosis cases and is the most feared, potentially life-threatening complication 1
- Splenomegaly occurs in approximately 50% of cases, making this restriction critical for all patients 1
What NOT to Use
- Do not use corticosteroids for routine treatment of uncomplicated infectious mononucleosis 2
- Corticosteroids are only indicated for respiratory compromise or severe pharyngeal edema causing airway obstruction 2, 5
- Prolonged steroid use in uncomplicated cases has been associated with severe complications including septic shock, polymicrobial bacteremia, and septic emboli 6
- Acyclovir and antihistamines are not recommended for routine treatment 2
When to Consider Corticosteroids (Rare Indications Only)
- Reserve corticosteroids exclusively for patients with impending airway obstruction from severe pharyngeal edema 2, 5
- Consider corticosteroids for hematological complications (severe thrombocytopenia or hemolytic anemia) 6, 5
- Use single low-dose oral dexamethasone (maximum 10 mg) if corticosteroids are indicated 3
Key Clinical Pitfalls
- Never prescribe antibiotics for infectious mononucleosis—the condition is viral and antibiotics provide no benefit 1, 7
- Avoid amoxicillin/ampicillin specifically, as these cause a characteristic rash in 90% of infectious mononucleosis patients 1
- Do not use the Centor criteria to guide antibiotic decisions in infectious mononucleosis—these criteria are designed for bacterial pharyngitis, not viral infections 4, 8
- Most patients recover uneventfully within 2-3 weeks, though fatigue and need for sleep may persist for several months 2, 5