# Infectious Mononucleosis (Glandular Fever) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC Infectious Mononucleosis Guidance 2022 · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Mononucleosis - disease-level clinical article (infectious-mononucleosis-clinical.txt) - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text INFECTIOUS MONONUCLEOSIS (GLANDULAR FEVER) Sources: CDC Infectious Mononucleosis Guidance 2022 · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) Review status: REVIEWED against MSF Essential Drugs 2024 - paracetamol (oral), Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560), Mononucleosis - disease-level clinical article (infectious-mononucleosis-clinical.txt), MSF Essential Drugs 2024 (ibuprofen oral monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - The classic triad is sore throat, swollen lymph nodes and fever, though how often all three appear varies between reported series [fever · lymphadenopathy · sore throat] - One large series found over 98 percent had sore throat, adenopathy, fever and enlarged tonsils together [fever · sore throat] - A separate series found the full triad far less consistently: roughly three-quarters had sore throat, just over half had adenopathy, and under half had fever [fever · sore throat] - Children under 5 are more likely than teenagers or adults to also show a rash and upper respiratory symptoms [rash] - Tiredness, headache and muscle or joint aches round out the common complaints [fatigue · headache · joint pain] SIGNS - what you find (4) - Neck lymph node swelling is usually symmetric, may be tender, and is most prominent in the first week of illness [lymphadenopathy] - Throat inflammation with tonsillar exudate is common and can look like strep throat - An enlarged spleen is found in roughly half of patients [splenomegaly] - The rash, when present, is a widespread flat-and-raised red eruption [rash] TESTS (7) - A complete blood count typically shows a raised white cell count with lymphocytosis and atypical lymphocytes - Lymphocytosis over 50 percent combined with atypical lymphocytes over 10 percent is about 99 percent sensitive for the diagnosis - Mild elevation of liver transaminases is a common lab finding - HIV testing is recommended for everyone with this picture, since acute HIV can give a false- negative antibody result - EBV-specific antibody testing is roughly 97 percent sensitive and 94 percent specific - The Monospot heterophile antibody test is cheaper and quicker but notably less sensitive, especially in young children - Imaging is reserved for concern about airway compromise, a ruptured spleen, or hemophagocytic lymphohistiocytosis IF NOT THIS - what else fits (4) - Group A strep, Arcanobacterium and other respiratory viruses such as adenovirus can mimic the presentation - CMV, acute HIV and toxoplasmosis are the other classic causes of a mononucleosis-like illness - Human herpesvirus 6 or 7 infection is also considered - Certain drugs - amoxicillin, ampicillin, minocycline, carbamazepine, phenytoin or dapsone - plus lymphoma round out the list Source StatPearls "Mononucleosis" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 500-1000 mg three or four times a day as needed, max 4000 mg daily Peds 15 mg/kg/dose [child max 500 mg] (Give every 4-6 hours as needed; maximum 4 doses in 24 hours (max 60 mg/kg/day) Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Choice Alternatives. Paracetamol first for the fever and sore throat of glandular fever; the spleen makes an NSAID the less comfortable default. Source MSF Essential Drugs 2024 - paracetamol (oral) Why Analgesic and antipyretic used for symptomatic relief of fever, sore throat, and malaise in infectious mononucleosis, a self-limiting viral illness with no antiviral treatment and managed supportively. Caution Rest and hydration are key; advise avoiding contact sports for 4 weeks due to risk of splenic rupture. Avoid amoxicillin or ampicillin as they cause a characteristic maculopapular rash in 90% of EBV patients. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Administer with caution to patients with hepatic impairment. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [1st line] Adult 400 mg every 6-8 hours with food as needed, max 1200 mg daily Peds 5-10 mg/kg/dose [child max 400 mg] (Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, maximum 30 mg/kg daily. The suspension's own label caps pain-and-fever use lower still, at 20 mg/kg/day in divided doses. Never exceed 400 mg in a single dose.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) for the adult dose: "The recommended dose is 200 mg-400 mg (10-20 ml), up to three times a day as required... do not take more than 1200 mg (60 ml) in any 24 hour period". That label's paediatric section gives weight bands and a 20 mg/kg/day pain-and-fever ceiling but states no mg/kg per dose, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)". Why NSAID alternative for pain and fever relief in infectious mononucleosis, given supportively alongside rest and hydration; caution needed in asthmatic children or renal impairment. Caution Caution in asthmatic children or renal impairment. Take with food to reduce gastric irritation. The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it. Do not give to children under 3 months of age. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Mononucleosis - disease-level clinical article (infectious-mononucleosis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Counsel on activity restriction and avoiding contact sports for 4 weeks, due to the risk of splenic rupture. RED FLAG - Urgent emergency referral is needed for airway obstruction. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)