Steroids for symptom control in infectious mononucleosis.
BACKGROUND
Glandular fever (infectious mononucleosis) is associated with fatigue, fever, sore throat and swollen lymph nodes. The severity of symptoms can vary. In extreme cases, breathing difficulties because of swelling in the throat and other complications can require hospitalization. The duration of symptoms is also variable; in some instances they can last for months. There are few treatments available. There are no universal criteria for using steroids in glandular fever. While their use is generally reserved for severe complications, there are reports of practitioners treating most symptomatic people with steroids. As glandular fever often affects young people at a time in their studies where they need to be continually productive, the potential duration of the condition is perhaps a key factor in prescribing such a potent drug for symptom control.


OBJECTIVE
To determine the efficacy and safety of steroid therapy for symptom control in glandular fever.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005); MEDLINE (January 1966 to November 2005); EMBASE (January 1974 to November 2005); and the UK National Research Register (November 2005).


METHODS
Randomised controlled trials (RCTs) that compared the effectiveness for symptom control of a steroid to placebo or to another intervention for people of any age with documented glandular fever were included.


METHODS
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.


RESULTS
Seven trials were included. The diagnosis, steroid regime, outcomes and methodological quality varied between trials. The sample size ranged from 24 to 94. For sore throat the results of two studies suggest a benefit at 12 hours of steroid therapy over placebo; however this benefit was not maintained. The evidence from one trial suggests a longer benefit when the steroid is combined with an antiviral drug. There was evidence from one trial 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 participants in the steroid group.


CONCLUSIONS
There is insufficient evidence - the trials were few, heterogeneous and some were of poor quality, to recommend steroid treatment for symptom control in glandular fever. There is also a lack of research on the side effects, potential adverse effects or complications, particularly in the long term.
Candy
B
B
National Patient Safety Agency, 4-8 Maple Street, London, UK W1T 5HD. bridget.candy@npsa.nhs.uk
Hotopf
M
M
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D006801:Humans; D007244:Infectious Mononucleosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D000305:Adrenal Cortex Hormones