From the Guidelines
The recommended treatment for Scarlet fever is antibiotics, specifically penicillin or amoxicillin for 10 days. For patients allergic to penicillin, alternatives include clindamycin, azithromycin, or clarithromycin 1. The standard dosage for children is typically amoxicillin 50 mg/kg/day divided into two or three doses (maximum 1000 mg/day), while adults usually receive 500 mg three times daily.
Key Considerations
- Treatment should begin promptly after diagnosis to reduce symptom duration, prevent complications, and decrease contagiousness.
- Supportive care is also important, including acetaminophen or ibuprofen for fever and discomfort, plenty of fluids to prevent dehydration, and rest.
- Patients should complete the full course of antibiotics even if symptoms improve quickly to ensure complete eradication of the Group A Streptococcus bacteria that causes scarlet fever.
- Most patients become non-contagious after 24 hours of antibiotic treatment and can return to school or work at that point, though they should continue to practice good hand hygiene 1.
Special Situations
- In cases of repeated episodes of acute pharyngitis, it is helpful to distinguish persistent carriage from recurrent episodes of acute GAS pharyngitis by considering the precise nature of the presenting signs and symptoms, the clinical response to antibiotic therapy, and the presence or absence of GAS pharyngitis in cultures of throat swabs obtained during asymptomatic intervals 1.
- For patients with frequent discrete episodes, serotyping or genotyping of streptococcal isolates recovered from specimens obtained during distinct episodes from an individual patient may also assist in arriving at this determination because a carrier has persistence of the same strain of GAS over time 1.
From the FDA Drug Label
The usual dosage recommendations for adults and children 12 years and over are as follows: Streptococcal infections - mild to moderately severe - of the upper respiratory tract and including scarlet fever and erysipelas: 125 mg to 250 mg (200,000 to 400,000 units) every 6 to 8 hours for 10 days
- The recommended treatment for Scarlet fever is penicillin (PO), with a dosage of 125 mg to 250 mg every 6 to 8 hours for 10 days 2.
- Alternatively, amoxicillin (PO) can be used, with a recommended dosage of 500 mg every 12 hours or 250 mg every 8 hours for 10 days to prevent the occurrence of acute rheumatic fever 3.
From the Research
Recommended Treatment for Scarlet Fever
The recommended treatment for Scarlet fever is primarily focused on eliminating the underlying cause of the disease, which is a group A beta-hemolytic streptococcal (GAS) infection.
- Antibiotic Therapy: The primary goal of treatment is to prevent acute rheumatic fever and other complications. Penicillin is the drug of choice for treating Scarlet fever, as it is cost-effective and has a long-standing proven efficacy 4.
- Alternative Antibiotics: For patients allergic to penicillin, alternative antibiotics such as macrolides (e.g., erythromycin, clarithromycin, azithromycin) and oral cephalosporins can be used 5, 4.
- Cefadroxil: Cefadroxil, a type of cephalosporin, has also been shown to be effective in treating Scarlet fever, especially in pediatric patients 6.
- Duration of Treatment: The recommended duration of antibiotic therapy varies depending on the specific antibiotic used. For example, penicillin, erythromycin, and clarithromycin are typically administered for 10 days, while azithromycin is administered for 5 days 5.
- Prevention of Complications: Prompt diagnosis and treatment of Scarlet fever are crucial to prevent rare but severe complications, such as invasive group A streptococcal infection and streptococcal toxic shock syndrome 7.
Prevention of Recurrences
For individuals who have had a previous attack of rheumatic fever, continuous antimicrobial prophylaxis is necessary to prevent recurrences 4.
- Secondary Prophylaxis: Penicillin is the agent of choice for secondary prophylaxis, but sulfadiazine or erythromycin can be used as alternatives in penicillin-allergic individuals 4.
- Duration of Prophylaxis: The duration of secondary prophylaxis depends on various factors, including the number of previous attacks, the time elapsed since the last attack, and the risk of exposure to streptococcal infections 4.