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 treatment for scarlet fever, which is caused by Streptococcus pyogenes, is amoxicillin for at least 10 days to prevent the occurrence of acute rheumatic fever 1 1.
- The dosage for adults and pediatric patients aged 3 months and older is as follows:
- Ear/Nose/Throat: 500 mg every 12 hours or 250 mg every 8 hours
- Skin/Skin Structure: 500 mg every 12 hours or 250 mg every 8 hours
- Genitourinary Tract: 500 mg every 12 hours or 250 mg every 8 hours
- For pediatric patients aged less than 12 weeks, the recommended upper dose of amoxicillin 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 is treated primarily with antibiotics, specifically penicillin or amoxicillin, with a recommended duration of 5-7 days, as a shorter course has been shown to be effective and safe 2. The choice of antibiotic depends on the patient's age, weight, and allergy status.
- For patients allergic to penicillin, alternatives include clindamycin, azithromycin, or clarithromycin.
- The standard dose for children is amoxicillin 50 mg/kg/day divided into three doses (maximum 1500 mg/day) or penicillin V 250 mg for children under 27 kg and 500 mg for those over 27 kg, taken 2-3 times daily.
- Adults typically receive penicillin V 500 mg twice daily or amoxicillin 500 mg three times daily. Supportive care is also important, including acetaminophen or ibuprofen for fever and pain, plenty of fluids to prevent dehydration, and rest. Antibiotics are crucial because they eliminate the group A Streptococcus bacteria causing the infection, reduce symptom duration, prevent transmission to others, and help prevent serious complications like rheumatic fever or kidney inflammation, as seen in studies 3, 4, 5, 6. Most patients show improvement within 24-48 hours of starting antibiotics, but the full course must be completed even if symptoms resolve earlier. It's worth noting that resistance to certain antibiotics, such as erythromycin and clindamycin, has been reported 5, 6, making penicillin a preferred choice for treating scarlet fever.