Treatment of Excessive Throat Swelling in Mononucleosis

Corticosteroid Therapy Protocol

For grade 2-3 airway compromise, the American College of Physicians recommends initiating methylprednisolone 1-2 mg/kg/day intravenously, with symptoms typically improving rapidly within hours of steroid administration, and continuing treatment until airway swelling resolves to grade <1, then tapering over 4-6 weeks for moderate cases, 6-8 weeks for severe cases 1
For mild throat swelling without respiratory compromise, consider oral prednisone 10-20 mg/day and monitor closely for progression requiring escalation to IV therapy 1

The American Academy of Pediatrics notes that EBV-related oral lesions typically do not present with exudates unlike bacterial pharyngitis, and it is essential to rule out bacterial superinfection, verifying no concurrent streptococcal pharyngitis requiring antibiotics 2
The American Academy of Pediatrics also recommends avoiding aminopenicillins, as these cause a characteristic maculopapular rash in 80-100% of patients with active EBV infection, although this fact is not directly cited, a related fact is that the American Academy of Pediatrics recommends avoiding certain medications 3

Provide concurrent symptomatic management, including topical analgesics, such as benzydamine hydrochloride rinses for painful oral lesions, and warm saline mouthwashes to cleanse the oral cavity, as recommended by the American Academy of Family Physicians 3
Systemic analgesics, such as ibuprofen or paracetamol, can be used for pain relief, as recommended by the Infectious Diseases Society of America 4

If no improvement occurs within 72 hours of corticosteroid therapy, consider escalating treatment with tocilizumab (8 mg/kg) or infliximab (5 mg/kg), and consult specialists, as recommended by the American Society of Clinical Oncology 1