Dawaa Reference

infectious

Infectious Mononucleosis (Glandular Fever)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

CDC Infectious Mononucleosis Guidance 2022 · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299)

Verified against4 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)
  • Mononucleosis - disease-level clinical article (infectious-mononucleosis-clinical.txt)
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • The classic triad is sore throat, swollen lymph nodes and fever, though how often all three appear varies between reported series [fever · lymphadenopathy · sore throat]
  • One large series found over 98 percent had sore throat, adenopathy, fever and enlarged tonsils together [fever · sore throat]
  • A separate series found the full triad far less consistently: roughly three-quarters had sore throat, just over half had adenopathy, and under half had fever [fever · sore throat]
  • Children under 5 are more likely than teenagers or adults to also show a rash and upper respiratory symptoms [rash]
  • Tiredness, headache and muscle or joint aches round out the common complaints [fatigue · headache · joint pain]

Signs — what you find (4)

  • Neck lymph node swelling is usually symmetric, may be tender, and is most prominent in the first week of illness [lymphadenopathy]
  • Throat inflammation with tonsillar exudate is common and can look like strep throat
  • An enlarged spleen is found in roughly half of patients [splenomegaly]
  • The rash, when present, is a widespread flat-and-raised red eruption [rash]

Tests (7)

  • A complete blood count typically shows a raised white cell count with lymphocytosis and atypical lymphocytes
  • Lymphocytosis over 50 percent combined with atypical lymphocytes over 10 percent is about 99 percent sensitive for the diagnosis
  • Mild elevation of liver transaminases is a common lab finding
  • HIV testing is recommended for everyone with this picture, since acute HIV can give a false-negative antibody result
  • EBV-specific antibody testing is roughly 97 percent sensitive and 94 percent specific
  • The Monospot heterophile antibody test is cheaper and quicker but notably less sensitive, especially in young children
  • Imaging is reserved for concern about airway compromise, a ruptured spleen, or hemophagocytic lymphohistiocytosis

If not this — what else fits (4)

  • Group A strep, Arcanobacterium and other respiratory viruses such as adenovirus can mimic the presentation
  • CMV, acute HIV and toxoplasmosis are the other classic causes of a mononucleosis-like illness
  • Human herpesvirus 6 or 7 infection is also considered
  • Certain drugs - amoxicillin, ampicillin, minocycline, carbamazepine, phenytoin or dapsone - plus lymphoma round out the list

SourceStatPearls "Mononucleosis" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500-1000 mg three or four times a day as needed, max 4000 mg daily

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(Give every 4-6 hours as needed; maximum 4 doses in 24 hours (max 60 mg/kg/day) Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Choice

Alternatives. Paracetamol first for the fever and sore throat of glandular fever; the spleen makes an NSAID the less comfortable default.

Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Analgesic and antipyretic used for symptomatic relief of fever, sore throat, and malaise in infectious mononucleosis, a self-limiting viral illness with no antiviral treatment and managed supportively.

Cautions
  • Rest and hydration are key; advise avoiding contact sports for 4 weeks due to risk of splenic rupture.
  • Avoid amoxicillin or ampicillin as they cause a characteristic maculopapular rash in 90% of EBV patients.
  • 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case.
  • Administer with caution to patients with hepatic impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg every 6-8 hours with food as needed, max 1200 mg daily

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, maximum 30 mg/kg daily. The suspension's own label caps pain-and-fever use lower still, at 20 mg/kg/day in divided doses. Never exceed 400 mg in a single dose.)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose source

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) for the adult dose: "The recommended dose is 200 mg-400 mg (10-20 ml), up to three times a day as required... do not take more than 1200 mg (60 ml) in any 24 hour period". That label's paediatric section gives weight bands and a 20 mg/kg/day pain-and-fever ceiling but states no mg/kg per dose, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)".

Why

NSAID alternative for pain and fever relief in infectious mononucleosis, given supportively alongside rest and hydration; caution needed in asthmatic children or renal impairment.

Cautions
  • Caution in asthmatic children or renal impairment.
  • Take with food to reduce gastric irritation.
  • The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it.
  • Do not give to children under 3 months of age.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Mononucleosis - disease-level clinical article (infectious-mononucleosis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Counsel on activity restriction and avoiding contact sports for 4 weeks, due to the risk of splenic rupture.
  • RED FLAG - Urgent emergency referral is needed for airway obstruction.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.