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Steroids for symptom control in infectious mononucleosis

2006; Cochrane; Linguagem: Inglês

10.1002/14651858.cd004402.pub2

1469-493X

Bridget Candy, Matthew Hotopf,

Herpesvirus Infections and Treatments

Background Infectious 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. Objectives To determine the efficacy and safety of steroids for symptom control in infectious mononucleosis. Search methods We 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 criteria Randomised 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 analysis We independently assessed trial inclusion. Where appropriate, it was intended to combine trial results in a meta‐analysis. Main results Seven 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' conclusions There 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.