From the Guidelines
The treatment for scarlet fever primarily involves antibiotics, specifically penicillin or amoxicillin, which are typically prescribed for a 10-day course to eliminate the group A Streptococcus bacteria causing the infection. For patients with penicillin allergies, alternatives include clindamycin, azithromycin, or clarithromycin 1. The standard dosage for children is usually amoxicillin 50 mg/kg/day divided into two or three doses, while adults typically receive 500 mg three times daily. Symptoms often improve within 24-48 hours of starting antibiotics, but completing the full course is essential to prevent complications like rheumatic fever or kidney inflammation.
Key Considerations
- The choice of antibiotic should be based on the patient's allergy history and the severity of the infection.
- Supportive care is also important, including:
- Acetaminophen or ibuprofen for fever and discomfort
- Plenty of fluids to prevent dehydration
- Rest
- A soft, cool diet may help with throat pain
- Patients are generally no longer contagious after 24 hours of antibiotic treatment and can usually return to normal activities at that point.
Prevention of Complications
The primary goal of treatment is to prevent complications such as rheumatic fever, which can be achieved with proper antibiotic treatment 1. The American Heart Association recommends penicillin as the first-line treatment for group A streptococcal pharyngitis, with alternatives for patients with penicillin allergies 1.
Management of Close Contacts
In cases where there is a high risk of transmission, such as in household contacts or institutional outbreaks, throat cultures and treatment may be necessary 1. However, this is typically not necessary for asymptomatic contacts.
Quality of Life
Treatment of scarlet fever with antibiotics can significantly improve quality of life by reducing symptoms and preventing complications. Completing the full course of antibiotics is essential to ensure complete recovery and prevent recurrence.
From the FDA Drug Label
The usual drug of choice in the treatment and prevention of streptococcal infections and the prophylaxis of rheumatic fever is penicillin administered by either the intramuscular or the oral route. The treatment for scarlet fever is penicillin.
- Penicillin is the drug of choice for the treatment and prevention of streptococcal infections, which cause scarlet fever 2.
- Clarithromycin may be effective in eradicating Streptococcus pyogenes from the nasopharynx, but data on its efficacy in preventing rheumatic fever are not available 3.
From the Research
Treatment Overview
The treatment for scarlet fever typically involves the use of antibiotics to speed up recovery, reduce the contagious period, and minimize the risk of complications 4.
Antibiotic Treatment
- The use of antibiotics such as penicillin has been shown to decrease the number of early and late complications, as well as reduce the number of carriers of beta-haemolytic streptococcus 5.
- In some cases, azithromycin may be prescribed to prevent complications and further spreading of the disease 6.
- However, the emergence of antibiotic-resistant strains of Streptococcus pyogenes, such as erythromycin-resistant strains, may complicate treatment 7.
Management of Complications
- Invasive Group A Streptococcus infections and streptococcal toxic shock syndrome are rare but severe complications of scarlet fever that require prompt diagnosis and treatment 8.
- The management of these complications may involve the use of antibiotics and supportive care to reduce mortality and improve outcomes.
Prevention of Outbreaks
- The prevention of outbreaks of scarlet fever in settings such as schools and day-care centers is crucial to reducing the spread of the disease 6, 7.
- Mandatory notification of infectious clusters and prompt investigation of outbreaks can help to identify the source and transmission dynamics of the disease, and inform strategies to prevent further spread.