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Hepatitis B - Management
How do I manage suspected or confirmed acute hepatitis B?

  • Admit the person to hospital if they are seriously ill, otherwise manage in primary care.
  • Notify the Health Protection Unit to facilitate appropriate surveillance.
  • Confirm the diagnosis with hepatitis serology (if not already confirmed).
    • If hepatitis B surface antigen (HBsAg) is detected, refer the person promptly to a specialist (hepatologist, infectious diseases physician, or gastroenterologist — depending upon local protocols).
  • Provide the person with information about hepatitis B, including advice on how to prevent transmission of the infection.
  • Review the person's current medications.
    • Stop any non-essential medication.
  • 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.
  • Treatment with antiviral agents is not routinely indicated for acute hepatitis B (except in cases of fulminant hepatitis).

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