Editing Infectious mononucleosis (section)

==Treatment==
Infectious mononucleosis is generally [[self-limiting (biology)|self-limiting]], so only symptomatic or supportive treatments are used.<ref name="Merck18">{{cite book |veditors=Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M |title=The Merck manual of diagnosis and therapy |edition=18th |publisher=Merck Research Laboratories |location=Whitehouse Station (NJ) |year=2006 |isbn=978-0-911910-18-6 |author=Mark H. Beers ... |url-access=registration |url=https://archive.org/details/merckmanual18the00mark }}</ref> The need for rest and return to usual activities after the acute phase of the infection may reasonably be based on the person's general energy levels.<ref name=Ebell2004/> Nevertheless, in an effort to decrease the risk of [[splenic rupture]], experts advise avoidance of [[contact sports]] and other heavy physical activity, especially when involving increased abdominal pressure or the [[Valsalva maneuver]] (as in [[rowing (sport)|rowing]] or [[weight training]]), for at least the first 3–4 weeks of illness or until enlargement of the spleen has resolved, as determined by a treating physician.<ref name=Ebell2004/><ref name=Putukian2008>{{cite journal|last=Putukian|first=M|author2=O'Connor, FG|author3=Stricker, P|author4=McGrew, C|author5=Hosey, RG|author6=Gordon, SM|author7=Kinderknecht, J|author8=Kriss, V|author9=Landry, G|title=Mononucleosis and athletic participation: an evidence-based subject review|journal=Clinical Journal of Sport Medicine|date=July 2008|volume=18|issue=4|pages=309–15|pmid=18614881|url=http://fammed.washington.edu/network/sfm/MonoReviewJuly2008%5B1%5D.pdf|access-date=18 June 2013|doi=10.1097/JSM.0b013e31817e34f8|s2cid=23780443|url-status=dead|archive-url=https://web.archive.org/web/20130923025409/http://fammed.washington.edu/network/sfm/MonoReviewJuly2008%5B1%5D.pdf|archive-date=23 September 2013}}</ref>

===Medications===
<!-- Pain meds -->
[[Paracetamol]] (acetaminophen) and [[non-steroidal anti-inflammatory drug|NSAIDs]], such as [[ibuprofen]], may be used to reduce fever and pain. [[Prednisone]], a [[corticosteroid]], while used to try to reduce throat pain or enlarged [[tonsils]], remains controversial due to the lack of evidence that it is effective and the potential for side effects.<ref>National Center for Emergency Medicine Informatics - Mononucleosis {{cite web |url=http://www.ncemi.org/cse/cse0314.htm |title=Mononucleosis (Glandular Fever) |access-date=2009-09-11 |url-status=dead |archive-url=https://web.archive.org/web/20090515154323/http://www.ncemi.org/cse/cse0314.htm |archive-date=2009-05-15 }}</ref><ref>{{Cite journal|last1=Rezk|first1=Emtithal|last2=Nofal|first2=Yazan H.|last3=Hamzeh|first3=Ammar|last4=Aboujaib|first4=Muhammed F.|last5=AlKheder|first5=Mohammad A.|last6=Al Hammad|first6=Muhammad F.|date=2015-11-08|title=Steroids for symptom control in infectious mononucleosis|journal=The Cochrane Database of Systematic Reviews|volume=2015 |issue=11|pages=CD004402|doi=10.1002/14651858.CD004402.pub3|issn=1469-493X|pmid=26558642|pmc=7047551}}</ref> Intravenous [[corticosteroid]]s, usually [[hydrocortisone]] or [[dexamethasone]], are not recommended for routine use but may be useful if there is a risk of airway obstruction, a [[thrombocytopenia|very low platelet count]], or [[hemolytic anemia]].<ref name="WebMD">{{cite web |title=Infectious Mononucleosis |url=http://www.webmd.com/hw/infection/hw168622.asp |date=January 24, 2006 |website=WebMD |access-date=2006-07-10 |url-status=live |archive-url=https://web.archive.org/web/20060706024151/http://www.webmd.com/hw/infection/hw168622.asp |archive-date=July 6, 2006 }}</ref><ref name="TGAntibiotic13">Antibiotic Expert Group. Therapeutic guidelines: Antibiotic. 13th ed. North Melbourne: Therapeutic Guidelines; 2006.</ref>

<!-- Antivirals -->
Antiviral agents act by inhibiting viral DNA replication.<ref name="pmid27933614" /> There is little evidence to support the use of antivirals such as [[aciclovir]] and [[valacyclovir]] although they 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=543–47 |year=1999 |pmid=10680982 |doi=10.1080/00365549950164409|last2=Tambini }}</ref><ref>{{cite journal|last1=De Paor|first1=M|last2=O'Brien|first2=K|last3=Fahey|first3=T|last4=Smith|first4=SM|title=Antiviral agents for infectious mononucleosis (glandular fever).|journal=The Cochrane Database of Systematic Reviews|date=8 December 2016|volume=2016|issue=12|pages=CD011487|pmid=27933614|doi=10.1002/14651858.CD011487.pub2|pmc=6463965}}</ref> Antivirals are expensive, risk causing resistance to antiviral agents, and (in 1% to 10% of cases) can cause unpleasant [[side effect]]s.<ref name="pmid27933614" /> Although antivirals are not recommended for people with simple infectious mononucleosis, they may be useful (in conjunction with steroids) in the management of severe EBV manifestations, such as EBV meningitis, peripheral neuritis, hepatitis, or hematologic complications.<ref name="pmid20739216">{{cite journal |vauthors=Rafailidis PI, Mavros MN, Kapaskelis A, Falagas ME |title=Antiviral treatment for severe EBV infections in apparently immunocompetent patients |journal=J. Clin. Virol. |volume=49 |issue=3 |pages=151–57 |year=2010 |pmid=20739216 |doi=10.1016/j.jcv.2010.07.008 }}</ref>

<!-- Antibiotics -->
Although antibiotics exert no antiviral action they may be indicated to treat bacterial [[secondary infection]]s of the throat,<ref name="Glandular fever">{{cite web | title = Glandular fever - NHS | url = http://www.nhs.uk/Conditions/Glandular-fever/Pages/Introduction.aspx | publisher = [[National Health Service (NHS)]] | date = 2010-09-09 | access-date = 2010-09-09 | url-status=live | archive-url = https://web.archive.org/web/20100908234618/http://www.nhs.uk/conditions/glandular-fever/pages/introduction.aspx | archive-date = 2010-09-08 }}</ref> such as with [[streptococcus]] ([[strep throat]]). However, [[ampicillin]] and [[amoxicillin]] are not recommended during acute [[Epstein–Barr virus]] infection as a diffuse rash may develop.<ref>{{cite book|last1=Tyring|first1=Stephen|last2=Moore|first2=Angela Yen|last3=Lupi|first3=Omar|title=Mucocutaneous Manifestations of Viral Diseases: An Illustrated Guide to Diagnosis and Management|date=2016|publisher=CRC Press|isbn=978-1-4200-7313-3|page=125|edition=2|url=https://books.google.com/books?id=uAjLBQAAQBAJ&pg=PA125|language=en|url-status=live|archive-url=https://web.archive.org/web/20170911003200/https://books.google.com/books?id=uAjLBQAAQBAJ&pg=PA125|archive-date=2017-09-11}}</ref>

===Observation===
[[Splenomegaly]] is a common symptom of infectious mononucleosis and health care providers may consider using [[abdominal ultrasonography]] to get insight into the enlargement of a person's spleen.<ref name="AMSSMfive">{{Citation |vauthors = ((American Medical Society for Sports Medicine))|date = 24 April 2014 |title = Five Things Physicians and Patients Should Question |publisher = American Medical Society for Sports Medicine |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-medical-society-for-sports-medicine/ |access-date = 29 July 2014 |url-status=live |archive-url = https://web.archive.org/web/20140729224526/http://www.choosingwisely.org/doctor-patient-lists/american-medical-society-for-sports-medicine/ |archive-date = 29 July 2014 }}, which cites
* {{cite journal|last1=Putukian|first1=M|last2=O'Connor|first2=FG|last3=Stricker|first3=P|last4=McGrew|first4=C|last5=Hosey|first5=RG|last6=Gordon|first6=SM|last7=Kinderknecht|first7=J|last8=Kriss|first8=V|last9=Landry|first9=G|title=Mononucleosis and athletic participation: an evidence-based subject review|journal=Clinical Journal of Sport Medicine|date=Jul 2008|volume=18|issue=4|pages=309–15|pmid=18614881|doi=10.1097/JSM.0b013e31817e34f8|s2cid=23780443}}
* {{cite journal|last1=Spielmann|first1=AL|last2=DeLong|first2=DM|last3=Kliewer|first3=MA|title=Sonographic evaluation of spleen size in tall healthy athletes.|journal=AJR. American Journal of Roentgenology|date=Jan 2005|volume=184|issue=1|pages=45–9|pmid=15615949|doi=10.2214/ajr.184.1.01840045}}</ref> However, because spleen size varies greatly, ultrasonography is not a valid technique for assessing spleen enlargement and should not be used in typical circumstances or to make routine decisions about fitness for playing sports.<ref name="AMSSMfive"/>