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What is the usual course and treatment of mono?
In most cases of mono, no specific treatment is necessary. The illness is usually self-limited and passes much the way other common viral illnesses resolve. Treatment is directed toward the relief of symptoms
and signs. Available antiviral drugs have no significant effect on the overall outcome of mono and may actually prolong the course of the illness. Occasionally, strep throat occurs in conjunction with mono and is best treated with penicillin or erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone). Ampicillin (Omnipen, Polycillin, Principen) and amoxicillin (Amoxil, DisperMox, Trimox) should be avoided if there is a possibility of mono since up to 90% of patients with mono develop a rash when taking these medications. If this happens, the individuals may then be inappropriately thought to have an allergy to penicillin.
For the most part, supportive or comfort measures are all that is necessary. Antiviral medications have not been shown to be of benefit. Acetaminophen (Tylenol)
or ibuprofen (Advil) can be given for fever and any headache or body aches. A sufficient amount of sleep and rest is important. The throat soreness is worst during the first five to seven days of illness and then subsides over the next seven to 10 days. The swollen, tender lymph nodes generally subside by the third week.
A feeling of fatigue or tiredness may persist for months following the acute phase of the illness. It is recommended that patients with mono avoid participation in any contact sports for three to four weeks after the onset of symptoms to prevent trauma to the enlarged spleen. The enlarged spleen is susceptible to rupture, which can be life-threatening. Cortisone medication is occasionally given for the treatment of severely swollen tonsils or throat tissues
that threaten to obstruct breathing.
Patients can continue to have virus particles present in their saliva for as long as 18 months after the initial infection. When symptoms persist for more than six months, the condition is frequently called "chronic" EBV infection or "chronic mononucleosis." However, laboratory tests generally cannot confirm continued active EBV infection in people with chronic EBV symptoms.