Antivirals for Infectious Mononucleosis

Problem

Infectious Mononucleosis (IM) is a clinical syndrome that is usually associated with EBV infection. Although generally not considered a serious illness, IM can lead to significant loss of time from school or work due to profound fatigue. Also, it can rarely lead to potentially life-threatening complications such as splenic rupture, encephalitis and severe upper airway obstruction. As such, there is great interest in developing regimens for treating IM with antiviral agents. Antiviral medications are known to be expensive, and there needs to be an evidence base for using these medications so that the available resources are used efficiently and effectively. There are no professional society guidelines currently for the management of IM. This indicated a lack of evidence regarding treatments and the importance of further evidence-based research. The objective of the review was to assess the effectiveness of antiviral medication for Infectious Mononucleosis.

Approach

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE, EMBASE, CINAHL, LILACS and Web of Science. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov along with the European Union Clinical Trials Register for completed and ongoing trials. We checked the reference lists of included trials to ensure that the main search had not missed any trials. We contacted the authors of included trials that were published in the last 10 years for the purpose of identifying missing trials. We included RCTs with participants of any age or sex with clinical and confirmed laboratory diagnosis of infectious mononucleosis who have had symptoms for 14 or fewer days. We excluded patients with recurrent or persistent IM or EBV infection. We included trials that examined the benefits and side effects of antiviral medication of any duration or dose or route of administration compared to placebo / no treatment. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Our primary outcomes were: Time to clinical recovery and Adverse events and side effects of medication.

Findings

The review is not yet complete, but preliminary findings indicate that there is no significant difference between treatment and control groups in relation to our primary outcomes.

Consequences

Currently there is not enough evidence to recommend antiviral treatment for Infectious Mononucleosis. Further primary research is required in this area.