Alcoholic hepatitis
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Management
- Supportive care including management for alcohol withdrawal, hydration, nutritional support
- Calculate Maddrey discriminant function
- Consider glucocorticoids for Maddrey of 32 or higher
- Prednisolone 40 mg p.o. daily, preferred over prednisone
- Methylprednisolone 32 mg IV daily, as alternative
- Duration is 28 days followed by a 16 day taper (decrease by 10 mg every 4 days until 10 mg, then by 5 mg every 3 days)
- Stopped early if no biochemical response within the first week (either Maddrey score or bilirubin)
- For those who have an indication for glucocorticoids but who cannot receive them, pentoxifylline 400 mg p.o. tid
References
- ^ Mark R. Thursz, Paul Richardson, Michael Allison, Andrew Austin, Megan Bowers, Christopher P. Day, Nichola Downs, Dermot Gleeson, Alastair MacGilchrist, Allister Grant, Steven Hood, Steven Masson, Anne McCune, Jane Mellor, John O’Grady, David Patch, Ian Ratcliffe, Paul Roderick, Louise Stanton, Nikhil Vergis, Mark Wright, Stephen Ryder, Ewan H. Forrest. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. New England Journal of Medicine. 2015;372(17):1619-1628. doi:10.1056/nejmoa1412278.
