Pediatric Mononucleosis and Epstein-Barr Virus Infection Medication

Updated: Nov 01, 2016
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

Acute infectious mononucleosis is treated symptomatically. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat fever and discomfort. Corticosteroids do not significantly alter the course of infectious mononucleosis. Although they ameliorate symptoms, corticosteroids should not be used in the treatment of uncomplicated disease. They are used in patients with significant upper airway obstruction due to tonsillar or lymph node hypertrophy and in patients with severe thrombocytopenia or hemolytic anemia.

Numerous drugs inhibit Epstein-Barr virus (EBV) replication in vitro. Nonetheless, antiviral agents are not beneficial in patients with uncomplicated infectious mononucleosis. However, antiviral agents are used in the treatment of patients with interstitial pneumonitis, X-linked lymphoproliferative syndrome, PTLD, HLH, and other lymphoproliferative disorders. [18, 19, 20, 21] Intravenous immunoglobulin may be considered to modulate immune function in the presence of disease complications due to autoantibodies.

New therapies, including the use of interferon alpha and the infusion of donor T cells or Epstein-Barr virus–specific cytotoxic T cells, are being studied.

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Glucocorticoids

Class Summary

Corticosteroids are potent anti-inflammatory drugs that also modify the immune response. They are used to decrease the size of tonsils and upper airway lymph nodes in the presence of airway compromise and possible upper airway obstruction. They may be useful to treat severe thrombocytopenia or hemolytic anemia. Whether prednisone should be used for myocarditis, pericarditis, or CNS system involvement is unclear.

Prednisone (Deltasone, Liquid Prep, Meticorten, Orasone, Prednicen-M, Sterapred)

Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Antiviral Agents

Class Summary

Numerous drugs inhibit Epstein-Barr virus replication in vitro. These include acyclovir, desciclovir, ganciclovir, interferon-alfa, interferon-gamma, adenine arabinoside, and phosphonoacetic acid. Acyclovir, which inhibits viral shedding from the oropharynx, is the only antiviral drug used to treat infectious mononucleosis in placebo-controlled clinical trials. However, the clinical course is not significantly affected in patients with uncomplicated infectious mononucleosis.

Foscarnet (Foscavir)

Foscarnet, a pyrophosphate analog, has been reported to be active against acyclovir- or ganciclovir-resistant herpes family viruses, including HSV, CMV, VZV, and EBV. Most of the data regarding its use in severe EBV infection are from isolated case reports, but they are generally positive.

Acyclovir (Zovirax)

Strains of HSV1 are most sensitive, followed by HSV2. Acyclovir also is sensitive to other herpesviruses, including, in descending order, varicella zoster, EBV, and CMV.

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Immunoglobulins

Class Summary

Intravenous immunoglobulin is used to modulate immune function in the presence of autoantibodies. It has been used successfully in the treatment of immune thrombocytopenia associated with infectious mononucleosis.

Intravenous immunoglobulin (Gammagard S/D, Gammar-P, Polygam)

Intravenous immunoglobulin neutralizes circulating myelin antibodies through antiidiotypic antibodies; it down-regulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks the complement cascade; promotes remyelination; and may increase CSF IgG (10%).

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