Corticosteroids Often Used In Treatment Of Infectious Mononucleosis

Corticosteroids are used often in the treatment of infectious mononucleosis, and for reasons beyond usual criteria, according to a study in the October issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

Systemic corticosteroid therapy (SCT) in the treatment of infectious mononucleosis has long been controversial, with conflicting results from different studies, according to background information in the article. The most consistently agreed on indication for SCT in the treatment of mononucleosis has been for complications involving severe airway compromise.

Scott K. Thompson, M.D., of the University of Rochester Medical Center, Rochester, N.Y., and colleagues analyzed the records of patients diagnosed with infectious mononucleosis from January 1998 to March 2003. Details of each patient's symptoms at the first visit, diagnosis, treatment and outcome were analyzed.

Systemic corticosteroid therapy was used in 44.7 percent of patients (92 of the 206 individuals included in the analysis), the researchers report. Evaluation of treatment indications for SCT showed that 8.0 percent of the study population qualified by traditional criteria for the use of corticosteroids, seven patients for "airway concern" and one patient for another indicated complication. "Factors associated with the observed increase in corticosteroid use included a history of repeat visits, inpatient admission, and otolaryngology consultation," the authors write.

"Despite consistent and uniform acceptance in the medical literature that SCT in the setting of IM [infectious mononucleosis] should be reserved for patients with impending airway obstruction, corticosteroids continue to be used on a much broader scale at this tertiary care institution," the authors conclude. "This observation suggests that clinicians see value in SCT for treatment of IM beyond the classically accepted reasons. Moreover, despite previous reports of possible adverse consequences of SCT in IM, our review failed to demonstrate any such trend."

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(Arch Otolaryngol Head Neck Surg. 2005; 131:900-904. Available pre-embargo to the media at www.jamamedia.org.)