Treatment of Hepatitis A
Hepatitis A treatment is primarily supportive care, focusing on hydration, rest, and symptomatic relief, as the infection is self-limited and does not require specific antiviral therapy. 1, 2
Supportive Management
- Provide adequate rest for symptomatic patients, especially during the acute phase when fatigue is prominent 2, 3
- Ensure proper hydration, which may require intravenous fluids in patients with severe nausea and vomiting 1, 2
- Administer symptomatic relief for nausea, vomiting, and abdominal discomfort as needed 2, 3
- Monitor liver function tests, particularly ALT, AST, bilirubin, and INR in patients with severe jaundice 2
- Avoid medications that might cause liver damage or are metabolized by the liver during the acute phase 1, 2
- No specific diet restrictions are necessary, though a high-calorie diet may be beneficial 3
- Abstain from alcohol consumption during the acute phase and recovery period 3
Indications for Hospitalization
- Dehydration due to persistent nausea and vomiting 1, 2
- Signs of acute liver failure, including prolonged INR and hepatic encephalopathy 2, 4
- Severe jaundice with significantly elevated bilirubin levels 2
- Older patients (>40 years) who are at higher risk for complications 4
- Patients with pre-existing liver disease who may experience a more severe course 5
Monitoring and Follow-up
- Regular assessment of liver function tests until normalization 2
- Monitor coagulation parameters (prothrombin time, factor V levels) in severe cases to assess risk of progression to fulminant hepatic failure 4
- Watch for signs of complications such as prolonged cholestasis or relapsing hepatitis, which occur rarely 6
Special Considerations
- Pregnant women, immunocompromised individuals, and those with pre-existing liver disease may experience more severe disease and require closer monitoring 5, 6
- The mortality rate for acute hepatitis A is generally low (0.3%) but increases in adults over 49 years (1.8%) 1
- Fulminant hepatic failure is rare (0.14-0.35% of hospitalized cases) but requires intensive monitoring and possible referral for liver transplantation in severe cases 4
Prevention After Exposure
- Administer hepatitis A vaccine to unvaccinated contacts within 2 weeks of exposure 2
- Consider immune globulin (IG) for close contacts at high risk of complications, particularly when exposure occurred within 2 weeks 2
- Hepatitis A vaccine can be administered simultaneously with IG at different injection sites if indicated 2