Brief Answer:
He should be rechecked by doctor before resuming contact sports.

Detailed Answer:
Hello and welcome,

Mono is very common in people your son's age, and by the time people are in their late 20s, most have had mono. Most people do not know when they get mono because they don't get the classic full blown very sick case of it and just think they have a bad cold. So most of us have had mono without knowing it.

But it sounds like your grandson has been quite sick, especially if the mono was complicated by strep. Strep is not uncommon in bad cases of mono as the tonsils are more susceptible to strep then.

The concern about contact sports is not because mono is contagious but rather because the lymphatic organs, including the liver and spleen, can become enlarged and more susceptible to injury in some cases of mono. So before returning to sports, your grandson should be feeling back to himself in terms of energy, and should have a physical exam where his doctor palpates the abdomen to check the liver and spleen size. If that is normal, and he is feeling well, then he can return to sports and other activities.

So how long does this take? It can range from one individual to the next and depends largely on how sick a person is from the mono.

For treatment of Strep, appropriate antibiotics are penicillin or amoxicillin. There is no reason to give a Zpack for this as it should be reserved for more resistant infections like pneumonia. Strep is still highly sensitive to the penicillin family of antibiotics. I would advise not seeing a physician's assistant or nurse practitioner in the future if possible because they do not have as much training as a doctor. Request specifically to see a doctor. But don't worry, the Zpack should kill the strep.

Mono is caused by a virus, so no antibiotic will treat that, but if the tonsils are so swollen that a child can't swallow then sometimes I give a short course of corticosteroid. But this is not necessary routinely. So taking no medicine for mono is appropriate.

So I would advise that your grandson return and see a real physician in a couple weeks to be examined for readiness to return to contact sports.

In terms of how long to be in bed, base that on how much energy he has. If he wants to be up and around that is fine too.

I hope this information helps.

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Brief Answer:
Encourage liquids.

Detailed Answer:
It's ok if he doesn't eat much right now but it is very important for him to keep up with fluids. If he is unable to drink fluids, then he may need to have an IV. This is not routine for mono but if kids are unable to swallow fluids, we do hospitalize them overnight sometimes so they can have IV fluids and sometimes prednisone.

If he is throwing up the azyithromycin (Z pack), consider crushing the pill up and mixing it in with some apple sauce or pudding rather than having him swallow the pill whole.

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