Question

• Can the severity and duration of symptoms in patients with uncomplicated infectious mononucleosis due to Epstein-Barr Virus (EBV) be reduced by treatment with steroids and acyclovir?

Clinical Bottom Lines

1. In a randomized, double-blind study, there was not found to be any significant clinical effect on the duration of overall symptoms by treatment with acyclovir and steroids.¹  There was a trend in favor of improvement of individual symptoms in first few days.
2. There was a statistically significant decrease in EBV replication (viral shedding) in treatment group - transient, during treatment. 
3. There was no impairment of establishment of EBV-specific immunity - humoral and cellular.
4. There were no adverse events in treatment group.

Summary of Key Evidence

1. 94 patients at onset, 81 followed clinically over initial 2 week period.  Patients were computer randomized into placebo and treatment groups.
2. This was a double blind study.  Both groups with similar demographic and laboratory features; EBV infection confirmed by serology. 
3. Treatment group given Acyclovir 800mg po 5x/d and prednisolone 0.7mg/kg/d x 4d, then weaned by 0.1mg/kg per day until stopped at day 10.  Equivalent IV meds used in some hospitalized patients. Matching placebos were provided for the control group.
4. Groups examined clinically with assessment scale regarding symptoms.  34 patients also selected for virologic and immunologic assessments to look at EBV replication, effects on EBV-specific immunity.

Additional Comments

• 94 patients at onset, 81 followed clinically over initial 2 week period.  Patients were computer randomized into placebo and treatment groups.
• This was a double blind study.  Both groups with similar demographic and laboratory features; EBV infection confirmed by serology.
• Treatment group given Acyclovir 800mg po 5x/d and prednisolone 0.7mg/kg/d x 4d, then weaned by 0.1mg/kg per day until stopped at day 10.  Equivalent IV meds used in some hospitalized patients. Matching placebos were provided for the control group.
• Groups examined clinically with assessment scale regarding symptoms.  34 patients also selected for virologic and immunologic assessments to look at EBV replication, effects on EBV-specific immunity.

Citation

1. Tynell E. Aurelius E. Brandell A. Julander I. Wood M. Yao QY. Rickinson A. Akerlund B. Andersson J. Acyclovir and prednisolone treatment of acute infectious mononucleosis: a multicenter, double-blind, placebo-controlled study. Journal of Infectious Diseases. 174(2):324-31, 1996.

CAT Author: Dennis Kim, MD

CAT Appraisers: John Frohna, MD

Date appraised: June 1999