Cochrane Review: Steroids for symptom control in infectious mononucleosis

Abstract

AbstractBackgroundInfectious mononucleosis (glandular fever) is associated with fatigue, fever, sore throat and swollen lymph nodes. The severity of symptoms can vary. In extreme cases, throat swelling can cause breathing difficulties and other complications requiring hospitalisation. The duration of symptoms is variable and 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 symptomatic people with steroids. Infectious mononucleosis 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 steroids for symptom control in infectious mononucleosis.Search methodsWe searched CENTRAL (2011, Issue 1), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to February Week 3, 2011) and EMBASE (1974 to February 2011).Selection criteriaRandomised controlled trials (RCTs) comparing the effectiveness of steroids with placebo or other interventions for symptom control for people with documented infectious mononucleosis.Data collection and analysisWe independently assessed trial inclusion. Where appropriate, it was intended to combine trial results in a meta‐analysis.Main resultsSeven trials were included. Heterogeneity between trials prevented combined analysis. Trials under‐reported methodological design features. Across the trials, no benefit was found in 8/10 assessments in health improvement. Two trials found at 12 hours benefit of steroid therapy over placebo in reducing sore throat (eight‐day course OR 21.00, 95% CI 1.94 to 227.20; one‐dose OR 4.20, 95% CI 1.08 to 16.32) but benefit was not maintained. In combination with an antiviral drug, another trial reported participants in the steroidal group had less pharyngeal discomfort between two to four days (OR 0.31, 95% CI 0.09 to 1.08). Across the trials effects on other common symptoms were less clear. Two trials set out to measure safety; they document no major adverse effects. In two other trials adverse events were reported, including respiratory distress and acute onset of diabetes. However, the association of the events with the steroid is not definite.Authors' conclusionsThere is insufficient evidence to recommend steroids for symptom control in infectious mononucleosis. There is a lack of research on the side effects, including potential adverse effects or long‐term complications.Plain Language SummarySteroids for short‐term symptom control in infectious mononucleosis (glandular fever)Glandular fever (infectious mononucleosis) is an infection carried in the saliva. Some people have no symptoms and young adults more commonly suffer symptomatic glandular fever. Common symptoms include fever, sore throat and swollen lymph nodes. The severity and duration of symptoms varies; a few people develop 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.This review identified four trials that compared the effectiveness of a steroid for short‐term symptom control in glandular fever to a placebo and three other trials that used a combination of steroid and a antiviral drug. In total they included 362 participants. Steroid treatment provided relief from sore throat in the short‐term (over 12 hours), in combination with an antiviral drug benefit was apparent at two to four days. However, these findings are limited because they were assessed in only one or two trials. Evidence of the effectiveness of steroids for other symptoms of glandular fever, or in combination with an antiviral drug, were less clear. We are unsure of adverse events from using steroids.