Management of Epstein-Barr virus (EBV) infection
Epstein–Barr virus (EBV) infection is usually self-limiting. Management consists of supportive care including pain relief (for analgesic regimens, see Mild, acute nociceptive pain) and, for some patients, a graded return to activity planSylvester, 2023. Early return to heavy exertion may result in prolonged symptoms. Advise patients to avoid strenuous activities that may lead to traumatic injury (eg contact sports) for at least 3 weeks after the onset of symptoms or until splenomegaly subsides to prevent splenic rupture, a rare but potentially life-threatening complicationPutukian, 2023Sylvester, 2023. The management approach should be individualised and guided by the person’s health and the activity-specific risksPutukian, 2023. Serial splenic ultrasound measurements may provide additional information to guide managementPutukian, 2023.
Antibiotics and antivirals are not indicated for EBV infection because they do not improve outcomesChovel-Sella, 2013De Paor, 2016Sylvester, 2023. The use of antibiotics in patients with EBV infection is associated with a risk of developing a rash that may be incorrectly attributed to hypersensitivitySylvester, 2023Zhang, 2023.
Corticosteroids are not routinely recommended for treatment of EBV infectionRezk, 2015Sylvester, 2023. Rarely, urgent hospitalisation is required for management of complications such as airway obstruction (for clinical features, see Clinical features associated with airway obstruction or deep neck space infection), haemolytic anaemia and severe thrombocytopenia (platelet count less than 20 × 109/L)Walter, 2002. In patients with severe complications, corticosteroids may have a role in treatment – seek expert adviceSylvester, 2023.