Mononucleosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
* [[Acyclovir]] decreases oropharyngeal viral shedding, but no clinical benefit | |||
* [[Glucocorticoids]] indicated only if: | |||
*:* Airway obstruction | |||
*:* Severe [[autoimmune hemolytic anemia]] ([[AIHA]]) | |||
*:* Severe [[thrombocytopenia]] | |||
== Treatment == | |||
* Supportive | |||
* No contact sports for 6-8 weeks | |||
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. Nevertheless heavy physical activity and contact sports should be avoided to abrogate the risk of splenic rupture, for at least one month following initial infection and until splenomegaly has resolved, as determined by [[Medical ultrasonography|ultrasound scan]].<ref name="Merck18"/> | |||
In terms of pharmacotherapies, [[paracetamol|acetaminophen/paracetamol]] or [[non-steroidal anti-inflammatory drug]]s (NSAIDs) may be used to reduce fever and pain – [[aspirin]] is not used due to the risk of [[Reye's syndrome]] in children and young adults. Intravenous [[corticosteroid]]s, 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> but may be useful if there is a risk of airway obstruction, 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> | |||
There is little evidence to support the use of [[aciclovir]], although it may reduce initial 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 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]]s 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 [[streptococcus|streptococcal]] infection in the throat and tonsils (strep throat). [[Penicillin]] or other antibiotics (with the exception of the two mentioned above) should be administered to treat the strep throat. [[Opioid]] analgesics are also contraindicated due to risk of [[respiratory depression]].<ref name="TGAntibiotic13" /> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
- Acyclovir decreases oropharyngeal viral shedding, but no clinical benefit
- Glucocorticoids indicated only if:
- Airway obstruction
- Severe autoimmune hemolytic anemia (AIHA)
- Severe thrombocytopenia
Treatment
- Supportive
- No contact sports for 6-8 weeks
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. Nevertheless heavy physical activity and contact sports should be avoided to abrogate the risk of splenic rupture, for at least one month following initial infection and until splenomegaly has resolved, as determined by ultrasound scan.[1]
In terms of pharmacotherapies, acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce fever and pain – aspirin is not used 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] but may be useful if there is a risk of airway obstruction, severe thrombocytopenia, or hemolytic anemia.[3][4]
There is little evidence to support the use of aciclovir, although it may reduce initial 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 two mentioned above) 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.