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Steroids for symptom control in infectious mononucleosisCandy B, Hotopf M
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SummaryUsing steroids for short-term symptom control in infectious mononucleosisGlandular fever (infectious mononucleosis) is an infection carried in the saliva and is associated with symptoms including fever, sore throat and swollen lymph nodes. Young adults are often affected and the severity and duration of symptoms varies from no symptoms, to developing breathing difficulties due to swelling at the back of the throat, and other complications requiring hospitalisation. Symptoms can last for months (it is a risk factor for chronic fatigue syndrome). Symptom relief and rest are commonly recommended treatments. The review identified four trials that compared the effectiveness of a steroid for short-term symptom control in glandular fever to a placebo and three trials that used a combination of steroid and another drug (antivirals or aspirin). Steroid treatment provided relief from sore throat in the short-term (over 12 hours), but this benefit was lost at two to four days. Clear evidence of the effectiveness of steroids for other symptoms of glandular fever, or in combination with an antiviral drug, was lacking. There is also potential for adverse effects from the use of steroids.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 19. 2006 AbstractBackgroundGlandular fever (infectious mononucleosis) is associated with fatigue, fever, sore throat and swollen lymph nodes. The severity of these symptoms can vary. In extreme cases, throat swelling can cause breathing difficulties and other complications requiring hospitalisation. The duration of symptoms is also variable; in some instances they can last for months. Few treatments are available and there are no universal criteria for using steroids in glandular fever. While steroids are generally reserved for severe complications, there are reports of practitioners treating most symptomatic people with steroids. Glandular fever often affects young people at a time in their education where they need to be continually productive, and the potential long duration of the condition is perhaps a key factor in prescribing such a potent drug for symptom control. ObjectivesTo determine the efficacy and safety of steroid therapy for symptom control in glandular fever. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 2) which includes the Acute Respiratory Infections Group's Specialized Register; MEDLINE (January 1966 to Week 4, April 2008); EMBASE (January 1974 to May 2008); and the UK National Research Register (September 2007). Selection criteriaRandomised controlled trials (RCTs) comparing the effectiveness of steroids with placebo or other interventions for symptom control for people with documented glandular fever. Data collection and analysisThe review authors independently assessed trial inclusion according to predetermined criteria. Results are presented separately for each symptom and, where possible, it was intended to combine results in a meta-analysis. Main resultsSeven trials were included. The diagnosis, steroid regimen, outcomes and methodological quality varied between trials. The sample size ranged from 24 to 94 participants. For sore throat two studies suggest a benefit of steroid therapy over placebo at 12 hours, but this benefit was not maintained. Another trial suggests a longer benefit when the steroid is combined with an antiviral drug. One trial showed that steroids may improve resolution of fatigue around four weeks. However, it is unclear if this is only in combination with an antiviral. Two trials reported severe complications in the steroid group participants. Authors' conclusionsThere is insufficient evidence to recommend steroid treatment for symptom control in glandular fever. The trials were few, heterogeneous and some were of poor quality. There is also a lack of research on the side effects, potential adverse effects or complications, particularly in the long-term. |