Mononucleosis medical therapy: Difference between revisions
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{{Mononucleosis}} | {{Mononucleosis}} | ||
{{CMG | {{CMG}} | ||
==Overview== | ==Overview== | ||
Infectious mononucleosis is generally self-limiting and only symptomatic and/or supportive treatments are used. However, severe tonsillar enlargement may cause life-threatening airway obstruction and therefore, close monitoring of such high-risk patients is essential. [[Glucocorticoids]] may be indicated in such cases of severe airway obstruction. [[Acyclovir]] has been tried as they decrease oropharyngeal viral shedding. Recently, [[valacyclovir]] has shown to lower or eliminate the presence of the [[EBV|Epstein-Barr virus]] in subjects afflicted with acute mononucleosis, leading to a significant decrease in the severity of symptoms. | Infectious mononucleosis is generally self-limiting and only symptomatic and/or supportive treatments are used. However, severe tonsillar enlargement may cause life-threatening airway obstruction and therefore, close monitoring of such high-risk patients is essential. [[Glucocorticoids]] may be indicated in such cases of severe airway obstruction. [[Acyclovir]] has been tried as they decrease oropharyngeal viral shedding. Recently, [[valacyclovir]] has shown to lower or eliminate the presence of the [[EBV|Epstein-Barr virus]] in subjects afflicted with acute mononucleosis, leading to a significant decrease in the severity of symptoms. | ||
== | ==Medical Therapy== | ||
===Supportive Therapy=== | |||
*Infectious mononucleosis is generally | *Infectious mononucleosis is generally self-limiting and only symptomatic and/or supportive treatments are used.<ref name="Merck18">{{cite book |editors=Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M, editors. |title=The Merck manual of diagnosis and therapy |edition=18th ed. |publisher=Merck Research Laboratories |location=Whitehouse Station (NJ) |year=2006 |isbn=0-911910-18-2}}</ref> | ||
*Rest is recommended during the acute phase of the infection, but activity should be resumed once acute symptoms have resolved (~3 weeks). | *Rest is recommended during the acute phase of the infection, but activity should be resumed once acute symptoms have resolved (~3 weeks). | ||
*Contact sports or heavy physical activity | *Contact sports or heavy physical activity should be avoided for a minimum 6-8 weeks or until [[splenomegaly]] has resolved as determined by [[Medical ultrasonography|ultrasound scan]], to abrogate the risk of [[splenic rupture]] which is a common complication among these patients.<ref name="Merck18"/> | ||
===Pharmacotherapy=== | |||
*Antipyretics such as [[paracetamol|acetaminophen/paracetamol]] or [[NSAID|non-steroidal anti-inflammatory drugs (NSAIDs)]] may be used to reduce [[fever]] and [[pain]]. However, [[aspirin]] is | *Antipyretics such as [[paracetamol|acetaminophen/paracetamol]] or [[NSAID|non-steroidal anti-inflammatory drugs (NSAIDs)]] may be used to reduce [[fever]] and [[pain]]. However, [[aspirin]] is avoided due to the risk of [[Reye's syndrome]] in children and young adults. | ||
*[[corticosteroid|Intravenous corticosteroids]], usually [[hydrocortisone]] or [[dexamethasone]], are not recommended for routine use.<ref>{{cite journal | author=Candy B, Hotopf M. | year=2006 | issue=4 | pages=CD004402 | journal=Cochrane Database Sys Rev | title=Steroids for symptom control in infectious mononucleosis | pmid=16856045 | doi=10.1002/14651858.CD004402.pub2 }}</ref> However, they may be used in cases of [[airway obstruction]], [[thrombocytopenia|severe thrombocytopenia]], or [[hemolytic anemia]].<ref name="TGAntibiotic13">Antibiotic Expert Group. Therapeutic guidelines: Antibiotic. 13th ed. North Melbourne: Therapeutic Guidelines; 2006.</ref><ref name="WebMD">{{cite web |title=Infectious Mononucleosis |url=http://www.webmd.com/hw/infection/hw168622.asp |date= Jan 24, 2006 |publisher=WebMD |accessdate=2006-07-10}}</ref> | *[[corticosteroid|Intravenous corticosteroids]], usually [[hydrocortisone]] or [[dexamethasone]], are not recommended for routine use.<ref>{{cite journal | author=Candy B, Hotopf M. | year=2006 | issue=4 | pages=CD004402 | journal=Cochrane Database Sys Rev | title=Steroids for symptom control in infectious mononucleosis | pmid=16856045 | doi=10.1002/14651858.CD004402.pub2 }}</ref> However, they may be used in cases of [[airway obstruction]], [[thrombocytopenia|severe thrombocytopenia]], or [[hemolytic anemia]].<ref name="TGAntibiotic13">Antibiotic Expert Group. Therapeutic guidelines: Antibiotic. 13th ed. North Melbourne: Therapeutic Guidelines; 2006.</ref><ref name="WebMD">{{cite web |title=Infectious Mononucleosis |url=http://www.webmd.com/hw/infection/hw168622.asp |date= Jan 24, 2006 |publisher=WebMD |accessdate=2006-07-10}}</ref> | ||
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*There is little evidence to support the use of [[acyclovir]], although it may reduce initial oropharyngeal viral shedding.<ref name="Torre1999">{{cite journal |author=Torre D, Tambini R |title=Acyclovir for treatment of infectious mononucleosis: a meta-analysis |journal=Scand. J. Infect. Dis. |volume=31 |issue=6 |pages=543–7 |year=1999 |pmid=10680982 |doi=}}</ref> However, the antiviral drug [[valacyclovir]] has recently been shown to lower or eliminate the presence of the [[EBV|Epstein-Barr virus]] in subjects afflicted with acute mononucleosis, leading to a significant decrease in the severity of symptoms.<ref name="pmid17369082">{{cite journal |author=Balfour HH, Hokanson KM, Schacherer RM, ''et al'' |title=A virologic pilot study of valacyclovir in infectious mononucleosis |journal=J. Clin. Virol. |volume=39 |issue=1 |pages=16–21 |year=2007 |pmid=17369082 |doi=10.1016/j.jcv.2007.02.002}}</ref><ref>{{cite journal |author=Simon et al. |title=The Effect of Valacyclovir and Prednisolone in Reducing Symptoms of EBV Illness In Children: A Double-Blind, Placebo-Controlled Study. |journal=International Pediatrics |volume=18 |issue=3 |pages=164-169 |year=2003 |month=March}}</ref><ref>{{cite journal |author=Balfour HH, Hokanson KM, Schacherer RM, ''et al'' |title=A virologic pilot study of valacyclovir in infectious mononucleosis |journal=J. Clin. Virol. |volume=39 |issue=1 |pages=16–21 |year=2007 |pmid=17369082 |doi=10.1016/j.jcv.2007.02.002}}</ref> | *There is little evidence to support the use of [[acyclovir]], although it may reduce initial oropharyngeal viral shedding.<ref name="Torre1999">{{cite journal |author=Torre D, Tambini R |title=Acyclovir for treatment of infectious mononucleosis: a meta-analysis |journal=Scand. J. Infect. Dis. |volume=31 |issue=6 |pages=543–7 |year=1999 |pmid=10680982 |doi=}}</ref> However, the antiviral drug [[valacyclovir]] has recently been shown to lower or eliminate the presence of the [[EBV|Epstein-Barr virus]] in subjects afflicted with acute mononucleosis, leading to a significant decrease in the severity of symptoms.<ref name="pmid17369082">{{cite journal |author=Balfour HH, Hokanson KM, Schacherer RM, ''et al'' |title=A virologic pilot study of valacyclovir in infectious mononucleosis |journal=J. Clin. Virol. |volume=39 |issue=1 |pages=16–21 |year=2007 |pmid=17369082 |doi=10.1016/j.jcv.2007.02.002}}</ref><ref>{{cite journal |author=Simon et al. |title=The Effect of Valacyclovir and Prednisolone in Reducing Symptoms of EBV Illness In Children: A Double-Blind, Placebo-Controlled Study. |journal=International Pediatrics |volume=18 |issue=3 |pages=164-169 |year=2003 |month=March}}</ref><ref>{{cite journal |author=Balfour HH, Hokanson KM, Schacherer RM, ''et al'' |title=A virologic pilot study of valacyclovir in infectious mononucleosis |journal=J. Clin. Virol. |volume=39 |issue=1 |pages=16–21 |year=2007 |pmid=17369082 |doi=10.1016/j.jcv.2007.02.002}}</ref> | ||
*[[Antibiotic|Antibiotics]] are not used as they are ineffective against viral infections. The antibiotics [[amoxicillin]] and [[ampicillin]] are | *[[Antibiotic|Antibiotics]] are not used as they are ineffective against viral infections. The antibiotics [[amoxicillin]] and [[ampicillin]] are contraindicated in the case of any coinciding bacterial infections during mononucleosis because their use can frequently precipitate a [[Drug eruption|non-allergic rash]]. | ||
:*In a small percentage of cases, mononucleosis infection is complicated by co-infection with [[streptococcus|streptococcal infection]] in the throat and tonsils ([[strep throat]]). [[Penicillin]] or other antibiotics (with the exception of the [[amoxicillin]] and [[ampicillin]]) should be administered to treat the [[strep throat]]. | :*In a small percentage of cases, mononucleosis infection is complicated by co-infection with [[streptococcus|streptococcal infection]] in the throat and tonsils ([[strep throat]]). [[Penicillin]] or other antibiotics (with the exception of the [[amoxicillin]] and [[ampicillin]]) should be administered to treat the [[strep throat]]. | ||
*[[Opioid|Opioid analgesics]] are also | *[[Opioid|Opioid analgesics]] are also contraindicated due to risk of [[respiratory depression]].<ref name="TGAntibiotic13" /> | ||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Medicine]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Lymphocytes]] | |||
[[Category:Viral diseases]] | |||
Latest revision as of 18:06, 18 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Infectious mononucleosis is generally self-limiting and only symptomatic and/or supportive treatments are used. However, severe tonsillar enlargement may cause life-threatening airway obstruction and therefore, close monitoring of such high-risk patients is essential. Glucocorticoids may be indicated in such cases of severe airway obstruction. Acyclovir has been tried as they decrease oropharyngeal viral shedding. Recently, valacyclovir has shown to lower or eliminate the presence of the Epstein-Barr virus in subjects afflicted with acute mononucleosis, leading to a significant decrease in the severity of symptoms.
Medical Therapy
Supportive Therapy
- Infectious mononucleosis is generally self-limiting and only symptomatic and/or supportive treatments are used.[1]
- Rest is recommended during the acute phase of the infection, but activity should be resumed once acute symptoms have resolved (~3 weeks).
- Contact sports or heavy physical activity should be avoided for a minimum 6-8 weeks or until splenomegaly has resolved as determined by ultrasound scan, to abrogate the risk of splenic rupture which is a common complication among these patients.[1]
Pharmacotherapy
- Antipyretics such as acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce fever and pain. However, aspirin is avoided due to the risk of Reye's syndrome in children and young adults.
- Intravenous corticosteroids, usually hydrocortisone or dexamethasone, are not recommended for routine use.[2] However, they may be used in cases of airway obstruction, severe thrombocytopenia, or hemolytic anemia.[3][4]
- There is little evidence to support the use of acyclovir, although it may reduce initial oropharyngeal viral shedding.[5] However, the antiviral drug valacyclovir has recently been shown to lower or eliminate the presence of the Epstein-Barr virus in subjects afflicted with acute mononucleosis, leading to a significant decrease in the severity of symptoms.[6][7][8]
- Antibiotics are not used as they are ineffective against viral infections. The antibiotics amoxicillin and ampicillin are contraindicated in the case of any coinciding bacterial infections during mononucleosis because their use can frequently precipitate a non-allergic rash.
- In a small percentage of cases, mononucleosis infection is complicated by co-infection with streptococcal infection in the throat and tonsils (strep throat). Penicillin or other antibiotics (with the exception of the amoxicillin and ampicillin) should be administered to treat the strep throat.
- Opioid analgesics are also contraindicated due to risk of respiratory depression.[3]
References
- ↑ 1.0 1.1 Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M, editors., eds. (2006). The Merck manual of diagnosis and therapy (18th ed. ed.). Whitehouse Station (NJ): Merck Research Laboratories. ISBN 0-911910-18-2.
- ↑ Candy B, Hotopf M. (2006). "Steroids for symptom control in infectious mononucleosis". Cochrane Database Sys Rev (4): CD004402. doi:10.1002/14651858.CD004402.pub2. PMID 16856045.
- ↑ 3.0 3.1 Antibiotic Expert Group. Therapeutic guidelines: Antibiotic. 13th ed. North Melbourne: Therapeutic Guidelines; 2006.
- ↑ "Infectious Mononucleosis". WebMD. Jan 24, 2006. Retrieved 2006-07-10.
- ↑ Torre D, Tambini R (1999). "Acyclovir for treatment of infectious mononucleosis: a meta-analysis". Scand. J. Infect. Dis. 31 (6): 543–7. PMID 10680982.
- ↑ Balfour HH, Hokanson KM, Schacherer RM; et al. (2007). "A virologic pilot study of valacyclovir in infectious mononucleosis". J. Clin. Virol. 39 (1): 16–21. doi:10.1016/j.jcv.2007.02.002. PMID 17369082.
- ↑ Simon; et al. (2003). "The Effect of Valacyclovir and Prednisolone in Reducing Symptoms of EBV Illness In Children: A Double-Blind, Placebo-Controlled Study". International Pediatrics. 18 (3): 164–169. Unknown parameter
|month=ignored (help) - ↑ Balfour HH, Hokanson KM, Schacherer RM; et al. (2007). "A virologic pilot study of valacyclovir in infectious mononucleosis". J. Clin. Virol. 39 (1): 16–21. doi:10.1016/j.jcv.2007.02.002. PMID 17369082.