How should I approach the management of a patient presenting with acute Hepatitis A infection?

Management of a patient presenting with acute Hepatitis A infection involves:

• Providing supportive symptomatic care, including advising rest and maintaining hydration.
• Using pain relief cautiously: ibuprofen may be prescribed with caution in mild to moderate hepatic impairment but avoided in severe cases; paracetamol should be avoided if possible due to increased toxicity risk; weak opioids like codeine should be used cautiously in mild impairment and avoided in severe impairment.
• Treating nausea with metoclopramide (for adults over 20 years, max 5 days) or cyclizine if liver impairment is mild.
• Managing itch with simple measures such as a cool environment and loose clothing; chlorphenamine may be used at night but avoided in severe liver impairment.
• Withholding potentially hepatotoxic drugs and seeking specialist advice if liver function worsens or if symptoms are difficult to manage.
• Monitoring liver function tests every 1 to 2 weeks until aminotransferase levels normalize (usually 4–12 weeks), with more frequent follow-up if symptomatic or jaundiced.
• Admitting to hospital if the patient becomes severely unwell, for example with vomiting, dehydration, or signs of hepatic decompensation.
• Advising the patient to avoid alcohol, work, school, or nursery until no longer infectious (typically 7 days after jaundice onset or symptoms if no jaundice).
• Implementing infection control measures: thorough hand washing, avoiding food handling if possible, avoiding unprotected sexual contact until non-infectious, and not sharing needles.
• Notifying the local Health Protection Unit promptly for surveillance, contact tracing, and preventive measures, especially if the patient is a food handler or in residential care.
• Providing patient information and considering referral to specialist services such as genito-urinary medicine or drug rehabilitation if appropriate.
• For pregnant women, informing the midwifery/obstetric team, advising on risks including possible preterm labour, and encouraging good hygiene; breastfeeding is not contraindicated.

This approach is based on expert opinion and UK guidelines from BASHH, UKHSA, WHO, and BMJ Best Practice ¹.