Are corticosteroids safe in adolescent and adult patients with infectious mononucleosis?

Infectious mononucleosis stems from the Epstein-Barr virus (EBV). EBV is generally spread through the saliva and can be acquired through kissing and sharing utensils or glassware during a meal with someone that has mono. Patients with mono may experience fatigue, fever, sore throat with exudates, swollen lymph nodes, or enlarged spleen. This study looked at whether usage of corticosteroids was safe in patients who had infectious mononucleosis with concomitant antibiotic therapy or was also safe without antibiotic therapy.

In this retrospective cohort study, 396 patients were admitted to the hospital with infectious mononucleosis. The median age was 19 years-old and more than half of the participants (52%) were male. A total of 155 patients (38.6% of the group) received 60 mg/day of methylprednisolone. Those who got the corticosteroids also received antibiotics (either Augmentin, Amoxicillin monotherapy, macrolides, or fluroquinolones). A total of 139/155 patients received both corticosteroids and concomitant antibiotic therapy. The rest of the 241 patients did not receive corticosteroids. Overall, 3/155 patients who were given corticosteroids with antibiotics were observed to have significant infectious complications (like cervical abscess, bacteremia, severe bacterial sepsis, or herpetic keratitis), while 7/241 patients who were not given corticosteroids were observed to have the same types of complications. The frequency of peritonsillar abscesses were also very low in both groups.

This study showed the use of systemic corticosteroids with concomitant antibiotic therapy is generally safe to use in both adolescents and adults alike. Infectious bacterial complications were rare, but seen in both cohorts. Many of the younger patients who had mono reported poor oral intake where corticosteroid administration helped tamp down the oropharyngeal inflammation. This study also found that there was no statistically significant difference in rates of hospital admission, length of stay, and complication incidences. If asked, I would administer corticosteroids with concomitant antibiotic therapy to patients who were suffering from infectious mononucleosis.