Therapy for acute and chronic hepatitis.

Review of therapy for acute and chronic hepatitis indicates no available medication is effective in acute, severe acute, or fulminant hepatitis. Management should include observation in acute hepatitis and meticulous medical care in severe acute and fulminant hepatitis. The only patients with chronic active hepatitis in whom steroid therapy has been shown effective are those who are hepatitis B surface antigen (HBsAG) negative and have symptomatic disease with morphologically severe lesions. Insufficient data have been generated to determine the need for and response to therapy in patients with asymptomatic or mild HBsAG-negative or HBsAG-positive disease or symptomatic, severe HBsAG-positive disease. Among the more novel therapies being evaluated, transfer factor and levamisole do not hold great promise. In contrast, antiviral chemotherapy with interferon and vidarabine may benefit patients with chronic hepatitis B, but this remains to be better defined. Finally, it has become apparent how crucial to objective evaluation is the properly executed randomized controlled trial. In the future, we can look forward to new therapy modes based on a better understanding of the immunopathogenesis of acute and chronic hepatitis.