What question did this study set out to answer?

The aim is to evaluate the use of antibiotics in adult patients experiencing infectious mononucleosis prehospital.

March 6, 2026

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

MBMaciej Bura MMMarcin MichalakPoznan University of Medical Sciences SDSandra DachowskaPoznan University of Medical Sciences

Key Result

82.6% of adult infectious mononucleosis patients received prehospital antibiotics, mostly broad-spectrum, often linked to more severe disease and steroid use.

Key Points

The aim is to evaluate the use of antibiotics in adult patients experiencing infectious mononucleosis prehospital.
Review of medical records for laboratory-confirmed infectious mononucleosis cases from 2006 to 2023.
Analysis of demographic, clinical, and laboratory parameters comparing treated and untreated patients.
Evaluation of antibiotic varieties prescribed in the prehospital period.
82.6% of patients were treated with antibiotics before hospital admission.
Common antibiotics included amoxicillin/clavulanate (46.2%), cefuroxime (27.7%), and macrolides (26.1%).
Palpebral edema occurred in one-fourth of patients, particularly those treated with antibiotics.
Almost 90% had spleen enlargement confirmed via abdominal ultrasound.
43.1% of patients received steroids, more frequently in those treated with antibiotics.

Structured PICO

What is the frequency and pattern of prehospital antibiotic use in adult patients admitted with infectious mononucleosis?

Population

144 adult patients with laboratory-confirmed infectious mononucleosis admitted to a single hospital in Poland between 2006 and 2023.

Intervention

Prehospital antibiotic therapy

Comparator

No prehospital antibiotic therapy

Outcome

Prehospital antibiotic use and comparison of demographic, clinical, and laboratory parameters between treated and untreated patients

A high proportion of young adults with infectious mononucleosis receive unnecessary broad-spectrum antibiotics in the prehospital setting, highlighting the need for better diagnostic evaluation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

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.

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