Table 1.

Current therapeutic interventions for management of alcoholic hepatitis.

Intervention Class	Examples, Indications and Limitations
Nutritional support	Address protein calorie malnutrition (High calorie meals and supplements), and vitamin deficiency (Vitamin A, Vitamin D, Thiamine, Folate) through supplementation.
Alcohol Abstinence	Most important component of therapy, often a multidisciplinary team recommended for successful management.
Corticosteroids	Prednisolone: first line therapy for severe AH (indicated with DF > 32 or HE) AASLD/EASL recommendations: 40mg/day for 4 weeks Assess response after a week: Lille score> 0.45, discontinue therapy Rule out infection and GI bleeding before initiating therapy
Phosphodiesterase inhibitor:	Pentoxifylline: inhibits TNF Second line agent. Not an effective rescue therapy agent.
Anti-TNF agents	Infliximab/Etanercept Large studies showed increased adverse effects: Infections, mortality Currently not recommended for AH
N-acetylcysteine	Replenishes Glutathione in damaged hepatocytes and prevents cell death. Used in Acute Hepatitis from other causes. Studies on Prednisolone and NAC combination therapy have shown reduction in 1-month mortality rate, HRS incidence, and Infection incidence, but no effect on improving 6-month mortality.

DF: Maddrey’s discriminant function, HE: Hepatic encephalopathy, TNF: Tumor necrosis factor, HRS: Hepatorenal Syndrome