伝染性単核球症の抗菌薬投与に関する検討

抄録

Infectious mononucleosis (IM), typically caused by the Epstein-Barr virus, is a commonly occurring, but self-limiting disease. However, its clinical findings and symptoms are very similar to those of tonsillitis or pharyngitis, and patients often receive treatment with antibiotics, which could result in the development of skin rashes or other side effects. However, the effect of antibiotic therapy for IM is still controversial; we have treated almost all our patients with IM by the same clinical pathway as that for acute tonsillitis or pharyngitis, which involves the use of antibiotics (ceftriaxone, clindamycin, or cefazolin). Therefore, we aimed to retrospective analysis of the data of our treated patients, aimed at improving our management of IM.

We analyzed the medical records of a total of 54 patients admitted to our department between 2013 and 2019, who met our diagnostic criteria for IM. The patients included 15 (27.8%) men and 39 (72.2%) women, ranging in age from 15–29 years (median 19 years), and the duration of hospitalization was 3–14 days (median 6 days). Pharyngeal culture was performed in 20 cases (37.0%), and pathogenic bacteria were isolated in 90% of cases. Thirty-nine patients (72.2%) had already received antibiotics before visiting our hospital; amoxicillin and cefditoren pivoxil were the most commonly prescribed (28.2%) antibiotics. The incidences of hepatic dysfunction and skin rashes were relatively low in patients who had received ceftriaxone, clindamycin, or cefazolin.

Amoxicillin use is known to be associated with a high incidence of skin rash in patients with IM, although our research demonstrated that patients who had received the antibiotic for less than 3 days were unlikely to develop skin rash. We believe that prescribing antibiotics to patients with IM is reasonable, and that especially when the diagnosis is still unclear, a very short course of amoxicillin is a helpful treatment option.