No new evidence to support the routine use of steroids in the treatment of infectious mononucleosis

Commentary on : Rezk E, Nofal YH, Hamzeh A, Aboujaib MF, Al Kheder MA, Al Hammad MF. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev 2015;11:CD004402. Infectious mononucleosis (IM) is a non-genetic syndrome, with the classic triad of fever, pharyngitis and cervical lymphadenopathy, and lymphocytosis. Over 90% of cases are caused by the Epstein-Barr virus, a subclinical infection in childhood, to which 95% of the population have seroconverted by adolescence.1 Infection after this time will result in IM, a more severe illness than bacterial tonsillitis.2 Attempts are ongoing to expand the treatment armamentarium.3 Some reports supported the use of corticosteroids, but others showed these effects to be short lived. A Cochrane review, in 2006, concluded that there was insufficient evidence and the trials were too few, heterogeneous and of poor quality to recommend steroid …