# Hepatitis B & C primary care referral - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022 · WHO Guidelines for Care and Treatment of Persons Diagnosed with HCV 2018 · WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024 · Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph) - Verified date: 2026-08 ## Verified against - Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022 - WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024 - Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph) - Hepatitis B & C primary care referral - disease-level clinical article (hepatitis-referral-clinical.txt) ## Treatment metadata - Sofosbuvir — 400 mg — oral.solid - Entecavir — 0.5 mg — oral.solid - Referral & safety-netting (no drug therapy) - Ribavirin — 200 mg — oral.solid ## Complete treatment card ```text HEPATITIS B & C PRIMARY CARE REFERRAL Sources: Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022 · WHO Guidelines for Care and Treatment of Persons Diagnosed with HCV 2018 · WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024 · Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph) Review status: REVIEWED against Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022, WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024, Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph), Hepatitis B & C primary care referral - disease-level clinical article (hepatitis-referral- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - The early prodromal phase can bring poor appetite, nausea, vomiting, malaise, itching, hives, joint pain, and tiredness, often mistaken for a stomach bug [fatigue · itching · joint pain · malaise · nausea · poor appetite · urticaria · vomiting] - As jaundice develops, urine darkens and stool becomes pale, sometimes with right upper belly pain and liver swelling [abdominal pain · jaundice · pallor] - Symptoms resolve and liver enzymes return to normal in the recovery phase - Hepatitis A can look like gastroenteritis or a viral chest infection, with tiredness, nausea, vomiting, fever, jaundice, poor appetite, and dark urine [fatigue · fever · jaundice · nausea · poor appetite · vomiting] - Loss of appetite, malaise, and tiredness are the most common early symptoms of hepatitis B [fatigue · malaise · poor appetite] - Eighty percent of people with hepatitis C stay symptom-free and never develop jaundice - Pregnant women infected with hepatitis E face a higher risk of dying from the infection SIGNS - what you find (4) - A low-grade fever can be present in viral hepatitis [fever] - Dry mucous membranes, a fast heart rate, and slow capillary refill point to dehydration [cold peripheries · dehydration · tachycardia] - In the jaundice phase, the skin and eyes turn yellow, hives can appear, and the liver becomes tender and enlarged [jaundice · urticaria] - Advanced liver failure can show fluid in the abdomen, leg swelling, and signs of malnutrition [leg swelling] TESTS (12) - A liver panel is the first test ordered when viral hepatitis is suspected - A markedly high alkaline phosphatase should raise concern for a blocked bile duct rather than hepatitis alone - Advanced liver disease can prolong the clotting time and lower the white cell and platelet counts - A raised serum ammonia is checked when confusion suggests hepatic encephalopathy - An IgM antibody to hepatitis A is the standard marker used to confirm a current infection - An IgG antibody to hepatitis A only shows a past infection and should not be used to diagnose a new one - Hepatitis B surface antigen persisting beyond six months defines a chronic infection - An IgM antibody to the hepatitis B core antigen is required to confirm an acute infection - One-time hepatitis C screening is recommended for every adult over 18 and for pregnant women in each pregnancy - A positive hepatitis C antibody test needs an HCV RNA test to confirm true infection - Liver scarring can be estimated from routine bloods using the AST/ALT ratio, the APRI score, or the Fibrosis-4 score - Hepatitis D needs an IgM anti-HBc test to tell a simultaneous co-infection apart from a new infection layered on chronic hepatitis B IF NOT THIS - what else fits (12) - Drug-induced hepatitis can look identical to viral hepatitis and is one of the leading causes of an emergency liver transplant - Hereditary haemochromatosis can cause pain in the knuckles of the first two fingers, a sign specific to that condition though not always present - Severe congestive heart failure can cause leg swelling, ascites, and an enlarged liver through hepatic congestion, resembling decompensated hepatitis - Viral hepatitis must be differentiated from a liver abscess - Viral hepatitis must be differentiated from hepatocellular cancer - Viral hepatitis must be differentiated from pancreatic cancer - Viral hepatitis must be differentiated from autoimmune hepatitis - Viral hepatitis must be differentiated from acute cholangitis - Viral hepatitis must be differentiated from acute cholecystitis and biliary colic - Viral hepatitis must be differentiated from pancreatitis - Viral hepatitis must be differentiated from gastroenteritis - Viral hepatitis must be differentiated from cholelithiasis Source StatPearls "Viral Hepatitis" - disease-level clinical article Status traced to the source above Rx: Hepatitis C | Hepatitis B | Main treatment HEPATITIS C 1. SOFOSBUVIR [1st line] Adult 400 mg once daily (in direct-acting antiviral combination regimen via specialist clinic) x 12 weeks (specialist prescribed) Peds Specialist pediatric hepatology referral required Source Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022 Why HCV direct-acting antiviral backbone in Egyptian 100 Million Seha viral hepatitis program Caution REFERRAL MANDATORY: Sofosbuvir must be prescribed within specialized viral hepatitis centers. Screen for HBV co-infection prior to starting HCV treatment (risk of HBV reactivation). Check liver function, renal function (eGFR < 30), and viral load baseline. Egypt ANDOHEPASUVIR 400MG 28 TAB ANDALOUS PHARMA 900.00 EGP (32.14/unit) AUGISPOV 400MG 28 TABLETS AUG PHARMA 900.00 EGP (32.14/unit) EPISOVIR 400MG 28 F.C. TABLETS EIPICO 900.00 EGP (32.14/unit) MPIVIROPACK 400MG 28 TABLETS MARCYRL PHARM... 900.00 EGP (32.14/unit) SERINOSPREVIR 400MG 28 TABLETS FUTURE PHARMA... 900.00 EGP (32.14/unit) SOFOSBUVIR-MUP 400MG 28 TABLETS MUP 900.00 EGP (32.14/unit) GRATISOVIR 400MG 28 TABLETS EUROPEAN EGYP... 1417.00 EGP (50.61/unit) SOVALDI 400MG 28 TABLETS GILEAD SCIENC... 4840.00 EGP (172.86/unit) HEPATITIS B 2. ENTECAVIR [1st line] Adult 0.5 mg once daily on an empty stomach (1 mg daily in decompensated cirrhosis) - long- term (specialist supervised) Peds Specialist pediatric hepatology referral required Source WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024 Why First-line nucleoside analogue for chronic HBV with low resistance rate Caution REFERRAL MANDATORY: Long-term viral suppression is required under specialist care. Do not stop abruptly due to risk of severe acute exacerbation of hepatitis. Adjust dose in renal impairment (eGFR < 50 mL/min). Egypt TECENTACAV 0.5 MG 10 F.C.TABS. PHARMED HEALT... 255.00 EGP (25.50/unit) LUDNOVIR 0.5 MG 10 TABS. MASH PREMIERE 274.00 EGP (27.40/unit) CAVICLUDE 0.5 MG 30 F.C. TABS. GLOBAL NAPI P... 900.00 EGP (30.00/unit) ENTECAVIR 0.5 MG 10 TAB. PENTA PHARMA-... 300.00 EGP (30.00/unit) TECAVIR 0.5MG 30 F.C. TAB. EVA PHARMA 1680.00 EGP (56.00/unit) BARACLUDE 0.5 MG 30 TABS. (NET PRICE) BRISTOL-MYERS SQUIBB 3720.00 EGP (124.00/unit) CLUDINETECH 0.5 MG 10 H.G.CAP EUROPEAN EGYP... 271.50 EGP ENTECAVIR 0.25MG/5ML ORAL SOLN. 210 ML GLOBAL NAPI PHARMACEUTICALS > PEN... 450.00 EGP -> ? strength differs, ? different route - not oral solid HEPACLUDE 0.5 MG / 10 ML ORAL SOL. 210 ML CHEMIPHARM 450.00 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Hepatitis B & C primary care referral - disease-level clinical article (hepatitis- referral-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Refer promptly to a gastroenterologist or hepatologist for disease progression or cirrhosis. 4. RIBAVIRIN [add-on - not a substitute] Adult Weight-based, with a direct-acting antiviral: under 75 kg, 1 g/day in 2 divided doses; 75 kg or more, 1.2 g/day in 2 divided doses. A low starting dose of 600 mg/day increased as tolerated is used where anaemia is a concern - Set by the hepatologist - depends on genotype, treatment history and cirrhosis status Peds 15 mg/kg/day [child max 1200 mg] (Children 3 years and over: under 47 kg, 15 mg/kg/day in 2 divided doses; 47-59 kg, 400 mg twice daily; 60-73 kg, 400 mg morning and 600 mg evening; over 73 kg, 600 mg twice daily. Paediatric hepatitis C is managed in a specialist centre.) 3 years and over: Under 47 kg, 15 mg/kg/day in 2 divided doses; 47 to 59 kg, 400 mg twice daily; 60 to 73 kg, 400 mg morning and 600 mg evening; over 73 kg, 600 mg twice daily. Specialist centre only. 3kg -> 45 mg/day 4kg -> 60 mg/day 5kg -> 75 mg/day 6kg -> 90 mg/day 7kg -> 105 mg/day 8kg -> 120 mg/day 9kg -> 135 mg/day 10kg -> 150 mg/day 11kg -> 165 mg/day 12kg -> 180 mg/day 13kg -> 195 mg/day 14kg -> 210 mg/day 15kg -> 225 mg/day 16kg -> 240 mg/day 17kg -> 255 mg/day 18kg -> 270 mg/day 19kg -> 285 mg/day 20kg -> 300 mg/day 21kg -> 315 mg/day 22kg -> 330 mg/day 23kg -> 345 mg/day 24kg -> 360 mg/day 25kg -> 375 mg/day 26kg -> 390 mg/day 27kg -> 405 mg/day 28kg -> 420 mg/day 29kg -> 435 mg/day 30kg -> 450 mg/day 31kg -> 465 mg/day 32kg -> 480 mg/day 33kg -> 495 mg/day 34kg -> 510 mg/day 35kg -> 525 mg/day 36kg -> 540 mg/day 37kg -> 555 mg/day 38kg -> 570 mg/day 39kg -> 585 mg/day 40kg -> 600 mg/day 41kg -> 615 mg/day 42kg -> 630 mg/day 43kg -> 645 mg/day 44kg -> 660 mg/day 45kg -> 675 mg/day 46kg -> 690 mg/day 47kg -> 705 mg/day 48kg -> 720 mg/day 49kg -> 735 mg/day 50kg -> 750 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph) Why 24 live products, a legacy of Egypt's hepatitis C programme. It still has a place in specific direct-acting antiviral regimens, so a search must not come back empty - but it is never given alone and never started in primary care. Caution Add-on only - ribavirin is never given as monotherapy and is combined with a direct- acting antiviral chosen by the treating hepatologist. Largely superseded: modern sofosbuvir-based regimens cure most Egyptian genotype 4 patients without ribavirin, so its appearance on a prescription should prompt a check that it is still needed. Haemolytic anaemia is the dose-limiting toxicity - check haemoglobin at baseline, week 2 and week 4; reduce the dose at 8.5-10 g/dL and stop permanently below 8.5 g/dL. Teratogen. Contraindicated in pregnancy AND in a male patient whose partner is pregnant. Effective contraception is needed during treatment and for months afterwards. CONTRAINDICATED in thalassaemia major and sickle cell disease - both are common in Egypt. Contraindicated if creatinine clearance is below 50 mL/min, and (tablets) in decompensated cirrhosis Child-Pugh B or C. Permanently discontinue if white cells fall below 1,000/mm3, neutrophils below 500/mm3, or platelets below 25 x 10^9/L. Egypt HEPAVERIN 200MG 170 CAPS. AMRIYA 244.00 EGP (1.44/unit) RIBOVINAL 200 MG 8 CAPS. MASH PREMIERE 12.00 EGP (1.50/unit) RIBAVIRIN 200MG 12 CAPS. MINA PHARM 22.00 EGP (1.83/unit) RIBAVARIN 200MG 12 CAPS. MEMPHIS 24.00 EGP (2.00/unit) RIBA 200MG 10 CAPS. GLOBAL NAPI P... 30.00 EGP (3.00/unit) PANVIRIN 200MG 10 CAPS. ALFACURE PHAR... 32.00 EGP (3.20/unit) RIBAVIRIN 200MG 10 CAPS. UP PHARMA 50.00 EGP (5.00/unit) RIBOVINAL 200 MG 21 STRIPS X 8 CAPS. MASH PREMIERE 252.00 EGP (31.50/unit) VIROKAN 100MG/5ML SYRUP 60ML HIKMA PHARMA 14.00 EGP -> ? strength differs, ? different route - not oral solid RIBAVIRIN SYRUP 100ML MEMPHIS 19.20 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)