Last reviewed 01/2018

  • 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.
  • symptoms usually settle in 2-3 weeks (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)
  • drugs not prescribed in IM include
    • Ampicillin and amoxycillin should not be used if there is any possibility of EBV infection as they cause a rash. Penicillin is apparently safer (2)
    • corticosteroids (3) - except in patients with impending airway obstruction, profound thrombocytopenia, haemolytic anaemia, severe cardiac involvement or neurologic disease (1,3)
    • Aciclovir – provides minimal benefit in management of IM (1)
  • Urgent medical referral may be required in patients with
    • severe or complicated disease
    • enlarged tonsils obstructing the airway
    • inadequate fluid intake (3)