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Treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • there is no specific treatment available for glandular fever. The reason why some children remain unwell for many weeks, or sometimes many months, is unclear.
  • acute symptoms usually settle in 2-3 weeks although malaise may persist for months (1)
  • the mainstay of treatment for infectious mononucleosis includes
    • good supportive care
      • adequate hydration
      • for fever and myalgias:
        • nonsteroidal anti-inflammatory drugs(NSAIDs)
        • paracetamol / acetaminophen
      • to relieve throat discomfort
        • throat lozenges
        • sprays
        • gargling with a 2%lidocaine (Xylocaine) solution
  • advice the patients that:
    • exclusion from school is not required for affected children (4)
    • vigorous activity should be avoided for at least three to four weeks (until splenomegaly resolves) due to risk of splenic rupture (1,5)
  • drugs not prescribed in IM include
    • ampicillin and amoxycillin - these should not be used if there is any possibility of EBV infection as they cause a rash. Penicillin is apparently safer (2)
    • corticosteroids (3,6) - except in patients with impending airway obstruction, profound thrombocytopenia, haemolytic anaemia, severe cardiac involvement or neurologic disease (1,3)
    • Antiviral treatments appear to provide minimal benefit in the management of IM (7)
  • Urgent medical referral may be required in patients with
    • severe or complicated disease
    • enlarged tonsils obstructing the airway
    • inadequate fluid intake (3)

Surgery is usually advocated for spontaneous splenic rupture (7)

 

References:

  1. Mohseni M et al. Mononucleosis. Treasure Island (FL): StatPearls Publishing. 2024 Jan
  2. Mark H. Ebell. Epstein-Barr Virus Infectious Mononucleosis. Am Fam Physician 2004;70:1279-87,1289-90.
  3. Charles PGP. Infectious mononucleosis. Australian Family Physician 2003;32(10)
  4. Guidance on infection control in schools and other childcare settings. UK Health Security Agency (September 2017 - last updated February 2023)
  5. O'Connor TE, Skinner LJ, Kiely P, et al. Return to contact sports following infectious mononucleosis: the role of serial ultrasonography. Ear Nose Throat J. 2011 Aug;90(8):E21-4.
  6. Rezk E, Nofal YH, Hamzeh A, et al. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev. 2015 Nov 8;(11)
  7. Vouloumanou EK, Rafailidis PI, Falagas ME. Current diagnosis and management of infectious mononucleosis. Curr Opin Hematol. 2012 Jan;19(1):14-20

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