Treatment

• 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