What is the management of Scarlet Fever?

From the Guidelines

Scarlet fever should be treated with penicillin, as it is the most effective antibiotic for this condition, with a recommended dosage of 2–4 million units every 4–6 h IV for adults and 100 000 units/kg/d for children. The management of scarlet fever involves the use of antibiotics to prevent complications and reduce symptom duration 1. Some key points to consider in the management of scarlet fever include:

• The use of penicillin as the first-line treatment, with alternatives such as clindamycin, vancomycin, linezolid, daptomycin, or telavancin for patients who are allergic to penicillin 1
• The importance of prompt treatment to prevent complications such as rheumatic fever, glomerulonephritis, and invasive infections
• The need for supportive care, including acetaminophen or ibuprofen for fever and discomfort, adequate hydration, and soft foods for sore throat relief
• The recommendation for patients to rest at home and avoid contact with others for at least 24 hours after starting antibiotics
• The characteristic rash typically resolves within a week, followed by skin peeling 1 It is essential to note that household contacts should monitor for symptoms but don't require prophylactic antibiotics unless they develop symptoms or are at high risk for complications 1.

From the FDA Drug Label

It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever.

The management of Scarlet Fever involves treating the underlying cause, which is a Streptococcus pyogenes infection.

• The recommended treatment duration for Streptococcus pyogenes infections, including Scarlet Fever, is at least 10 days with amoxicillin to prevent the occurrence of acute rheumatic fever 2.
• The dosage for Scarlet Fever is not explicitly stated, but for Streptococcus pyogenes infections, the recommended dosage is:
  • For adults and pediatric patients aged 3 months and older:
    • Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours
    • Severe: 875 mg every 12 hours or 500 mg every 8 hours
  • For pediatric patients aged less than 12 weeks:
    • The recommended upper dose is 30 mg/kg/day divided every 12 hours.
• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained.

From the Research

Scarlet Fever Management

• Scarlet fever is an infection caused by toxin-producing strains of Streptococcus pyogenes, and its management involves treating patients with antibiotics to reduce the risk of complications and the spread of infection 3, 4.
• The typical symptoms of scarlet fever include a distinctive macro-papular rash, usually in children, and patients who have these symptoms should be prescribed a suitable antibiotic such as phenoxymethylpenicillin (Penicillin V) immediately 3.
• National guidance recommends treating people with scarlet fever with antibiotics regardless of the severity of illness to speed recovery, reduce the length of time the infection is contagious, and reduce the risk of complications 4.
• In some cases, azithromycin may be used to treat scarlet fever, especially in outbreaks where person-to-person transmission is suspected 5.

Antibiotic Resistance

• There is a high incidence of group A Streptococcus (GAS) infections, and the GAS isolates have a high resistance rate to erythromycin and clindamycin 6.
• Penicillin is the antibiotic of choice for GAS infections, and the common emm types associated with scarlet fever are emm12 and emm1 6.
• Other antibiotics such as ceftriaxone and vancomycin may also be effective against GAS isolates, but the choice of antibiotic should be based on the severity of the illness, suspected causative organism, and culture/sensitivity results 6, 7.

Treatment Approaches

• Topical antibiotics may be used to treat mild and localized impetigo, while systemic antibiotics such as cloxacillin, erythromycin, azithromycin, or cephalexin may be used to treat widespread or severe impetigo and ecthyma 7.
• Folliculitis, furunculosis, and carbuncle can be treated with topical or systemic antibiotics such as cloxacillin, cephalexin, erythromycin, amoxicillin/clavulanic acid, or vancomycin 7.
• Erysipelas and cellulitis require systemic antibiotics such as oral or intravenous penicillin, erythromycin, cephalexin, cloxacillin, vancomycin, minocycline, or ciprofloxacin, depending on the severity and suspected causative organism 7.