Emerging treatments

Antivirals

One Cochrane review, which included 7 randomized controlled trials and 333 patients, found that the efficacy of antivirals (e.g., acyclovir, valacyclovir) in IM is uncertain, and the quality of evidence is very low. An improvement in time taken to recover (by 5 days) occurred in patients who received antiviral treatment, but the result was not precise and measurement for improvement was not clearly defined.[68] Acyclovir has been found to temporarily reduce viral shedding in the oropharynx, but it is not beneficial in resolving symptoms of disease or reducing the rate of complications.[69] Even though the role of antivirals in the management of severe Epstein-Barr virus (EBV) infections is debatable, physicians may consider using antiviral agents in severe manifestations of EBV infections, in immunocompetent patients, as an adjunct to corticosteroid treatment.[43][70] There have also been small studies and case reports of successful treatment of severe acute IM with foscarnet (combined with prednisone and intravenous immune globulin), valacyclovir, ganciclovir, and valganciclovir.[71][72][73][74] 

Pidotimod

An investigational synthetic dipeptide molecule with immunostimulatory properties. A preliminary randomized controlled study in children found that pidotimod shortened time to resolution, with approximately 90% of patients recovering by 2 weeks, while only 20% of controls recovered within the same time frame. Pidotimod also decreased the risk of secondary infection.[75] Further research is required.

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