From the Guidelines
Scarlet fever, a strep infection with a characteristic red rash, requires prompt antibiotic treatment with penicillin as the first-line treatment, typically prescribed as oral penicillin V (250-500 mg 2-4 times daily for 10 days for adults; children's dosing is weight-based) or a single intramuscular injection of benzathine penicillin G, as recommended by the Infectious Diseases Society of America 1.
Treatment Options
- For penicillin-allergic patients, alternatives include erythromycin (250-500 mg four times daily for 10 days), azithromycin (500 mg on day 1, then 250 mg daily for 4 more days), or clindamycin (300 mg three times daily for 10 days) 1.
- Complete the full course of antibiotics even if symptoms improve quickly.
Supportive Care
- Supportive care includes acetaminophen or ibuprofen for fever and discomfort, plenty of fluids, and rest 1.
- The rash, which feels like sandpaper and typically starts on the neck and chest before spreading, usually fades within a week.
Prevention of Complications
- Antibiotics are crucial not only to reduce symptom duration but also to prevent serious complications like rheumatic fever, kidney inflammation, and the spread of infection to others 1.
- Patients are generally no longer contagious after 24 hours of antibiotic treatment but should stay home from work or school during this period.
Special Considerations
- For patients with recurrent pharyngitis and laboratory evidence of group A streptococcus, antibiotics may be considered in certain situations, such as during a community outbreak of acute rheumatic fever or when the patient has a family or personal history of acute rheumatic fever 1.
From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (10-day minimum); otherwise the sequelae of streptococcal disease may occur. The treatment for strep infection with scarlet rash is penicillin V (PO), with a minimum therapy duration of 10 days to eliminate the organism and prevent sequelae of streptococcal disease 2.
- The patient should be advised to take the medication exactly as directed and complete the full course of therapy.
- Cultures should be taken after completion of treatment to determine whether streptococci have been eradicated.
From the Research
Treatment Options for Strep Infection with Scarlet Rash
- The treatment for strep infection with scarlet rash typically involves antimicrobial therapy, with the goal of reducing symptoms, preventing complications, and minimizing disease transmission 3.
- Oral penicillin V and amoxicillin are considered the drugs of choice for treating group A streptococcal pharyngitis, which can cause a scarlet rash 3.
- For patients with a non-anaphylactic allergy to penicillin, oral cephalosporin is an acceptable alternative, while patients with a history of immediate, anaphylactic-type hypersensitivity to penicillin may be treated with oral clindamycin, clarithromycin, or azithromycin 3.
Efficacy of Different Antimicrobial Regimens
- A study comparing 5-day clarithromycin, 5-day amoxicillin/clavulanate, and 10-day penicillin V regimens found that all three had similar clinical efficacy, but amoxicillin/clavulanate and penicillin V were more effective in eradicating the bacteria 4.
- Another study found that a 3-day azithromycin regimen had similar clinical efficacy to a 10-day penicillin V regimen, but was less effective in eradicating the bacteria 5.
- The choice of antimicrobial regimen may depend on factors such as the patient's allergy history, the presence of resistant bacterial strains, and the severity of symptoms 4, 5, 3.
Importance of Early Diagnosis and Treatment
- Early diagnosis and treatment of group A streptococcal pharyngitis are crucial to prevent suppurative and non-suppurative complications, reduce symptom severity, and shorten the duration of illness 3.
- Microbiologic testing, such as culture or rapid antigen detection test, is essential to confirm the diagnosis and guide antimicrobial therapy 3.