Antiviral agents for infectious mononucleosis (glandular fever)

• Published in: Cochrane database of systematic reviews 2016-12, Vol.12 (12), p.CD011487
• Main Authors: De Paor, Muireann, O'Brien, Kirsty, Fahey, Tom, Smith, Susan M
• Format: Article
• Language: English
• Subjects: Acute Disease; Acyclovir - adverse effects; Acyclovir - analogs & derivatives; Acyclovir - therapeutic use; Adolescent; Adult; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Child; Child health; Child, Preschool; Female; Guanine - adverse effects; Guanine - analogs & derivatives; Guanine - therapeutic use; Humans; Infectious disease; Infectious mononucleosis (Glandular fever); Infectious Mononucleosis - drug therapy; Insurance medicine; Lungs & airways; Male; Randomized Controlled Trials as Topic; Valacyclovir; Valine - adverse effects; Valine - analogs & derivatives; Valine - therapeutic use; Young Adult
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD011487.pub2

Infectious mononucleosis (IM) is a clinical syndrome, usually caused by the Epstein Barr virus (EPV), characterised by lymphadenopathy, fever and sore throat. Most cases of symptomatic IM occur in older teenagers or young adults. Usually IM is a benign self-limiting illness and requires only symptomatic treatment. However, occasionally the disease course can be complicated or prolonged and lead to decreased productivity in terms of school or work. Antiviral medications have been used to treat IM, but the use of antivirals for IM is controversial. They may be effective by preventing viral replication which helps to keep the virus inactive. However, there are no guidelines for antivirals in IM. To assess the effects of antiviral therapy for infectious mononucleosis (IM). We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, March 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1946 to 15 April 2016), Embase (1974 to 15 April 2016), CINAHL (1981 to 15 April 2016), LILACS (1982 to 15 April 2016) and Web of Science (1955 to 15 April 2016). We searched the World Health Organization (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov for completed and ongoing trials. We included randomised controlled trials (RCTs) comparing antivirals versus placebo or no treatment in IM. We included trials of immunocompetent participants of any age or sex with clinical and laboratory-confirmed diagnosis of IM, who had symptoms for up to 14 days. Our primary outcomes were time to clinical recovery and adverse events and side effects of medication. Secondary outcomes included duration of abnormal clinical examination, complications, viral shedding, health-related quality of life, days missing from school or work and economic outcomes. Two review authors independently assessed studies for inclusion, assessed the included studies' risk of bias and extracted data using a customised data extraction sheet. We used the GRADE criteria to rate the quality of the evidence. We pooled heterogeneous data where possible, and presented the results narratively where we could not statistically combine data. We included seven RCTs with a total of 333 participants in our review. Three trials studied hospitalised patients, two trials were conducted in an outpatient setting, while the trial setting was unclear in two studies. Participants' ages ranged from two years to young adults. The t