Antibiotic therapy in adult patients with infectious mononucleosis in the prehospital period – a single-center experience

Introduction: Some viral pharyngitis can mimic streptococcal pharyngitis. The clinical similarity of infectious mononucleosis (IM) and streptococcal pharyngitis makes differential diagnosis based on the clinical picture alone tricky, and patients with IM may be treated empirically with antibiotics (ATBs). Aim: To assess prehospital ATB use in adult patients with IM admitted to the hospital. In addition, to compare antibiotic-treated individuals and patients not treated with ATBs using selected demographic, clinical, and laboratory parameters. Materials and methods: Medical records of patients with a laboratory-confirmed IM diagnosis (2006-2023) from one center in Poland were analyzed. Results: Out of one hundred and forty-four patients, 119 (82.6%) were treated with ATBs in the prehospital period. Many patients (n = 59) received more than one ATB. The most common choices were amoxicillin/clavulanate (46.2%), cefuroxime (27.7%), and macrolides (26.1%). One-fourth of patients had palpebral edema (more commonly in subjects treated with ATBs). The enlarged spleen was found in almost 90% of individuals with an available abdominal ultrasound assessment (113/127). A significant proportion of patients (43.1%) were given steroids (more commonly in subjects treated with ATBs). Conclusions: More severe IM in young adults is a common cause of ATB therapy. Broad-spectrum ATBs are often prescribed. Meticulous clinical evaluation supported by simple and widely available diagnostic tools could reduce the use of antimicrobials in such a patient population.