How Mononucleosis Is Treated

Doctor checks patient for swollen lymph nodes

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Mononucleosis (mono) is a viral illness most commonly caused by the Epstein-Barr virus (EBV), though it can be caused by other viruses. Treatment involves managing symptoms while your body fights the infection. Symptoms can include extreme fatigue, sore throat, and swollen tonsils.

Getting plenty of rest, drinking ample fluids, and taking over-the-counter (OTC) fever and pain relievers can help you recover. Prescription medication usually isn't needed, but corticosteroids can help reduce overly swollen tonsils in extreme cases.

This article covers the various home remedies, OTC and prescription medications, and other care strategies that can help you manage your mono symptoms and recover as quickly as possible.

How to treat mononucleosis.

Verywell / Ellen Lindner

Home Remedies and Lifestyle

The primary treatment for mono involves rest and home remedies to relieve symptoms. Give your immune system the boost it needs to fight mono with the following tactics:

Hydrate: Fever and pain when swallowing can you put you at risk for dehydration. Prevent dehydration by drinking two to three cups of water per hour, or more if your fever is causing you to sweat.

Rest: Don't underestimate the power of rest to help your immune system do its job. You'll especially need to get lots of rest in the first week or two that you are sick. This doesn't mean you have to stay in bed all the time, but you should greatly limit your activity.

While stimulants, like caffeine, might seem like a good idea when you're tired, it's best to let yourself rest. Avoid anything that will interfere with you getting quality sleep, which your immune system needs to stay strong. Kids with mono should be encouraged to take a break from active play.

Control Your Fever: Lowering the temperature of your room, taking a lukewarm (not cold) bath, and putting a cold washcloth on your forehead can help keep your fever down.

If your fever remains uncontrolled after ten days, you should seek medical attention to avoid dangerous complications.

Reduce Sore Throat and Tonsil Swelling: The sore throat that comes with mono can be quite severe. Mono can cause tonsils to swell so much that they almost touch each other. You might also notice that your tonsils have a whitish-yellow covering.

A warm salt water gargle can help soothe your tonsils. You can also drink cold beverages, eat frozen yogurt or ice cream, or have a popsicle.

Soothe Body Aches: You can use ice packs or heating pads to relieve body aches, taking care to never apply ice directly to your skin. If your body aches (or any other symptoms) become intolerable, contact your healthcare provider.

Protect Your Spleen: It is important to avoid contact sports, heavy lifting, and strenuous activities when you have mono. The illness commonly causes an enlarged spleen, which can rupture upon even the most mild pressure or hit to the abdomen. A ruptured spleen is a medical emergency.

It is a good idea to avoid heavy chores around the house as well. Children should be discouraged from rough play or wrestling with siblings. Wait at least until all your mono symptoms have resolved, then return to your physical activities gradually.

Avoid Alcohol: Mono can also cause the liver to become inflamed—a transient condition known as mono hepatitis. Take it easy on your liver and avoid drinking alcohol while you have mono symptoms or are recovering.

Many people recover from mono within two to four weeks. However, some people continue to feel fatigued for several weeks longer. In some cases, mono symptoms can last for six months or more.

Over-the-Counter Therapies

You can typically manage a sore throat, fever, and body aches by using OTC pain relievers like Tylenol (acetaminophen) and Motrin (ibuprofen). You can also find throat lozenges and sprays to soothe a sore throat. 

Check with your healthcare provider for advice on the appropriate pain and fever reducers, dosages, and timing for your age group or that of your child.

Adults may use aspirin, but it should not be given to anyone under the age of 19 due to the risk of a rare but life-threatening condition called Reye's syndrome. The risk of developing Reye's is higher when a child takes aspirin during or shortly after a viral illness, such as mono.

Aspirin belongs to a family of compounds called salicylates. While many salicylates share the same properties as aspirin, their effects on the body can vary. Taking too many salicylates at any age can lead to salicylate toxicity (overdose).

To avoid this medical emergency, check all OTC products you are using for aspirin and other salicylates, including acetylsalicylate, acetylsalicylic acid, and salicylic acid.

People younger than 19 should avoid using oral or topical medications that contain these ingredients as long as they have mono symptoms. Adults ages 19 and up should avoid using more than one salicylate or aspirin-containing product at a time.

Keep in mind that OTC pain relief ointments that contain menthol, such as Tiger Balm and Icy-Hot can contain salicylates as well. While topical salicylates have not been proven to be associated with Reye's syndrome, some people choose to avoid them until age 19.

Contact your healthcare provider if you have any questions about which medications you or your child should take when sick with mono.

Prescriptions

Swollen tonsils and lymph nodes usually are not a big deal and go away on their own. However, if they become so swollen that they interfere with swallowing or breathing, you need treatment right away.

Sometimes steroid medications are used to shrink the tonsils if they have become too enlarged. Corticosteroids can also be used if there are complications, such as very low platelet count or hemolytic anemia, in which your body does not make enough red blood cells fast enough.

An extremely painful sore throat might even prompt a prescription narcotic.

Antibiotics are not used for mononucleosis because it is a viral disease. However, the symptoms can be mistaken for strep throat, in which case you may be prescribed an antibiotic.

Some people who take amoxicillin or other forms of penicillin develop a rash even though they are not allergic to the drug. When a person has mono, their chances of developing this rash are higher.

It is possible to have strep throat or a bacterial sinus infection at the same time that you have mono. If this happens, you may be prescribed an antibiotic that is less likely to produce a rash.

There have been studies on using antiviral therapy for Epstein-Barr virus infectious mononucleosis, especially in patients who are at risk due to being immunocompromised. A review of this research found that any benefit was uncertain. The drugs used included acyclovir, valomaciclovir, and valacyclovir.

Mono can result in other complications that may require prescription medication, which will vary based on the course of the illness.

Mononucleosis Healthcare Provider Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Summary

Mono is a viral illness, so it is not treated with antibiotics. Ample rest and hydration are critical for your immune system to fight the infection.

Over-the-counter medications can help keep your fever down and relieve aches, though children under 19 years of age should avoid medications that contain aspirin. Due to the risk of rupturing your spleen while sick with mono, you should avoid physical activities until your symptoms have passed.

A Word From Verywell

A common myth about mono is that you can only get it once. That's not exactly true. Once you become infected with Epstein-Barr virus, you will carry the virus for the rest of your life. The virus usually stays dormant and most people will never have mono symptoms again.

There is a chance, however, that EBV will reactivate and cause illness, mostly in people with weakened immune systems. If you have AIDS, autoimmune disease, cancer, or another condition that affects your autoimmune system, talk to your healthcare provider about how to reduce your risk.

Frequently Asked Questions

  • What's the quickest way to recover from mono?

    Because it's a viral infection, there are no medications for mononucleosis: The illness simply needs to run its course. That said, you can help speed your recovery by getting lots of rest, especially when you first become ill, and drinking plenty of fluids.

  • Is mononucleosis a serious disease?

    Not usually. For most people, the most serious aspect of the illness is missed time from work, school, and social activities. One common side effect to be aware of is an enlarged spleen, which can be vulnerable to rupture during vigorous activities or contact sports. Don't engage in either until your healthcare provider says it's OK.

  • How long is mono contagious?

    Experts aren't totally sure. There's no question a person with mononucleosis is contagious while they have symptoms, which typically last for four weeks or more. However, after they recover, the Epstein-Barr virus that most often causes mono remains dormant (inactive) in their body permanently, but that doesn't mean someone is infectious for the rest of their lives. There's a small chance it could become active again and could be transmissible via saliva.

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