From the Research
The primary treatment for pediatric scarlet fever is a full course of antibiotics, typically penicillin or amoxicillin, as recommended by the most recent and highest quality study 1. For children, amoxicillin is often prescribed at 50 mg/kg/day divided into two or three doses for 10 days. If the child is allergic to penicillin, alternatives include erythromycin (40 mg/kg/day divided into 2-4 doses for 10 days) or clindamycin (20-30 mg/kg/day divided into three doses for 10 days) 1. It's crucial to complete the entire antibiotic course even if symptoms improve quickly to prevent complications like rheumatic fever or kidney inflammation. Supportive care is also important, including:
- Acetaminophen or ibuprofen for fever and discomfort (dosed by weight according to package instructions)
- Plenty of fluids to prevent dehydration
- Soft foods if the child has a sore throat A cool-mist humidifier and saltwater gargles (for older children) may help soothe throat discomfort. Antibiotics work by killing the Group A Streptococcus bacteria causing the infection, and most children feel better within 24-48 hours after starting treatment, though the characteristic rash may take several days to fade completely 1. Children should stay home from school or daycare until they've been on antibiotics for at least 24 hours and no longer have a fever. The diagnosis of scarlet fever should be confirmed by microbiologic testing, such as a rapid antigen detection test or culture, before initiating antimicrobial therapy 1. In cases where penicillin fails to eradicate the infection, alternative treatments such as cephalosporin or clindamycin may be considered 2. It's also important to note that scarlet fever can be associated with other complications, such as hepatitis, and patients should be monitored for these potential complications 3.