What is the treatment for scarlet fever?

From the Guidelines

The treatment for scarlet fever primarily involves antibiotics, specifically penicillin, which is the preferred choice due to its proven efficacy, safety, narrow spectrum, and low cost, as recommended by the Infectious Diseases Society of America 1. The goal of treatment is to eliminate the group A Streptococcus bacteria causing the infection and prevent complications.

• Penicillin is typically prescribed for a 10-day course, with intramuscular benzathine penicillin G preferred for patients who are unlikely to complete a full 10-day course of oral therapy.
• For patients allergic to penicillin, alternatives include erythromycin, which is a suitable option 1.
• Supportive care is also important, including acetaminophen or ibuprofen for fever and discomfort, plenty of fluids to prevent dehydration, and rest.
• A cool mist humidifier can help soothe a sore throat, and soft foods may be easier to swallow.
• Patients remain contagious until they've been on antibiotics for 24 hours, so they should stay home during this period to prevent spreading the infection to others. In cases where there are close contacts or outbreaks, throat cultures may be performed, and treatment with antimicrobials may be necessary for those with positive cultures, as outlined in the management of close contacts and pharyngeal carriers 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 Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. The treatment for scarlet fever, which is caused by Streptococcus pyogenes, is typically an antibiotic.

• The recommended treatment is penicillin by the intramuscular route for at least 10 days to prevent the occurrence of acute rheumatic fever 2 3.
• Alternative treatments, such as amoxicillin or azithromycin, may be used in patients who cannot use first-line therapy 2 3.

From the Research

Treatment of Scarlet Fever

The treatment of scarlet fever typically involves the use of antibiotics to speed recovery, reduce the length of time the infection is contagious, and reduce the risk of complications 4.

• Antibiotic Treatment: National guidance recommends treating people with scarlet fever with antibiotics regardless of the severity of illness 4.
• Types of Antibiotics: Different antibiotics, such as penicillin, cephalosporins, and macrolides, can be used to treat scarlet fever, but the choice of antibiotic may depend on various factors, including the severity of the illness and the presence of any allergies or resistance 5.
• Effectiveness of Antibiotics: The effectiveness of antibiotics in treating scarlet fever can vary, and some studies have found that certain antibiotics, such as carbacephem, may be more effective than others, such as penicillin, in resolving symptoms 5.
• Resistance and Sensitivity: The increasing resistance of Group A Streptococcus to antibiotics, including penicillin and macrolides, is a concern and may affect the treatment of scarlet fever 6.
• Recent Trends: Recent studies have shown an increase in the incidence of group A streptococcal infections, including scarlet fever, and an increase in antibiotic prescriptions, particularly for azithromycin, during the COVID-19 pandemic and in 2022 7.

Considerations for Treatment

When treating scarlet fever, it is essential to consider the potential risks and benefits of antibiotic treatment, as well as the possibility of resistance and sensitivity to different antibiotics 5, 6.

• Monitoring and Follow-up: Patients with scarlet fever should be monitored closely for any signs of complications or resistance to treatment, and follow-up appointments should be scheduled to ensure that the infection has been fully resolved 4.
• Public Health Considerations: The treatment of scarlet fever also has public health implications, as the infection can be contagious and may require measures to prevent transmission to others 4, 7.