• Notify the local Health Protection Unit promptly — hepatitis A is a notifiable disease.
• There is no specific anti-viral treatment for hepatitis A.
• Review the person's medication.
• Stop non-essential medication during the acute illness.
• Avoid using sedatives in those with severe disease (because of the risk of sedation and coma).
• If pain relief is required, suitable options include:
• Ibuprofen.
• Paracetamol — normal dosages can be used, unless there is evidence of moderate or severe liver impairment. If serum bilirubin is greater than 300 micromoles/L or prothrombin time is greater than 3 seconds, reduce to a maximum of 1 g twice or three times a day.
• A weak opioid (such as codeine) may be used if liver impairment is mild. Avoid codeine in severe liver impairment (enhanced sedative effects and reduced clearance).
• If treatment of nausea is required, and liver impairment is mild, offer metoclopramide or cyclizine at normal dosage. Seek specialist advice on the dosage and choice of anti–emetic if the person has more severe liver impairment.
• Itch can be difficult to treat.
• Advise simple measures (such as maintaining a cool, well-ventilated environment, wearing loose clothing, and avoiding hot baths or showers).
• Consider offering chlorphenamine at normal dosage at night (although avoid this in severe liver impairment). This can be increased to use every 4–6 hours if itch is severe. Ursodeoxycholic acid, colestyramine, and corticosteroids are other treatment options — seek specialist advice before prescribing.
• Monitor liver function and prothrombin time. As a general guide:
• Monitor liver function and prothrombin time 3–5 days after diagnosis, then weekly until improvement is seen. Monitoring can then be reduced to fortnightly and then monthly until liver function normalizes (usually 4–12 weeks).
• If the person is jaundiced or symptomatic, monitor twice a week.
• Monitor every 1–2 days in people with more severe liver disease (for example where aspartate aminotransferase [AST] or alanine aminotransferase [ALT] is greater than 2000 IU/L, bilirubin is greater than 300 micromoles/L, or prothrombin time is greater than 3 seconds).
• Screen for other sexually transmitted infections, if sexually-acquired hepatitis is suspected.
• Advise the person to:
• Rest when necessary.
• Avoid drinking alcohol during the acute illness.
• Return if there is any deterioration in their condition.

• Arrange emergency hospital admission if the person is:
• Severely ill.
• Vomiting.
• Dehydrated.
• Showing signs of hepatic decompensation (change in level of consciousness or personality, or prolongation of prothrombin time of 5 seconds or more).

• Give verbal and written advice on hygiene to the infected person and all family members.
• Family members may already have acquired hepatitis A and be excreting the virus, so strict hygiene is important to prevent further transmission.
• Emphasize the importance of hand washing after going to the toilet.
• Hand washing should be supervised after toileting, where necessary (for example people who may have difficulty with personal hygiene, especially children).
• People caring for very young children should wash their hands immediately after changing nappies or toileting (including handling a potty).
• The person should avoid handling food, if possible.
• The person should avoid unprotected sexual intercourse (until they are no longer infectious).
• Advise the infected person that they must not attend work, school, or nursery until 7 days after the onset of jaundice (or 7 days after symptom onset if there is no history of jaundice).
• Advise that breastfeeding can continue, as long as the woman uses the hygiene precautions above.
• Contact tracing will be done via the public health authorities, who have a duty of confidentiality to the infected person.

For information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk), or the British National Formulary (BNF) (www.bnf.org).