What should I do if I develop a rash after being treated for strep throat?

Management of Rash After Strep Throat Treatment

If you develop a rash after being treated for strep throat, you should contact your healthcare provider, as this may represent an allergic reaction to the antibiotic requiring medication discontinuation and alternative treatment. 1, 2

Understanding the Rash

A rash following strep throat treatment is commonly due to one of these causes:

1. Antibiotic allergy: Particularly common with penicillins (including amoxicillin) and can range from mild to severe
2. Viral exanthem: If you had viral pharyngitis misdiagnosed as strep throat
3. Scarlet fever: A toxin-mediated rash associated with certain strains of Group A Streptococcus
4. Mononucleosis: A high percentage of patients with mononucleosis who receive amoxicillin develop an erythematous skin rash 2

Assessment Algorithm

Step 1: Evaluate the rash characteristics

• Timing: When did it appear in relation to starting antibiotics?
• Appearance: Is it diffuse, localized, flat, raised, or blistering?
• Associated symptoms: Fever, itching, difficulty breathing, swelling of face/lips

Step 2: Determine severity

• Mild: Localized rash without systemic symptoms
• Moderate: More extensive rash with mild systemic symptoms
• Severe: Extensive rash with severe symptoms (breathing difficulty, facial swelling, blistering)

Action Plan Based on Severity

For Mild Rash:

• Contact your healthcare provider to report the rash
• Continue to monitor for worsening symptoms
• Take antihistamines if recommended by your provider for itching
• Document when the rash appeared in relation to starting antibiotics

For Moderate Rash:

• Stop the antibiotic immediately
• Contact your healthcare provider urgently for assessment
• Take antihistamines if recommended for symptom relief
• Prepare for alternative antibiotic therapy if strep treatment needs to be completed

For Severe Rash or Anaphylactic Symptoms:

• Seek emergency medical care immediately
• Stop the antibiotic immediately
• Use epinephrine auto-injector if prescribed and available for severe allergic reactions

Alternative Antibiotic Options

If the rash is determined to be an allergic reaction to the antibiotic, your healthcare provider may prescribe an alternative:

• If allergic to penicillin/amoxicillin:
  • Clindamycin (10 days)
  • Clarithromycin (10 days)
  • Azithromycin (5 days)
  • First-generation cephalosporin (if not anaphylactically sensitive to penicillin) 1, 3

Important Considerations

• Complete the full course of the alternative antibiotic to prevent complications like acute rheumatic fever 3
• Document the allergic reaction for future reference
• Avoid the suspected allergen in future treatments

Common Pitfalls to Avoid

1. Not distinguishing between true allergy and side effect: Not all rashes indicate a true allergy. Your healthcare provider needs to make this determination.

2. Stopping antibiotics without consultation: Unless symptoms are severe, consult with your healthcare provider before discontinuing medication.

3. Misattributing viral rash to antibiotic allergy: A high percentage of patients with mononucleosis who receive amoxicillin develop a rash that is not a true allergy 2.

4. Ignoring the rash: Even mild rashes can progress to severe reactions and should be reported promptly.

5. Self-medicating: Do not take additional medications without medical advice, as they may mask symptoms or interact with current treatments.

By promptly recognizing and appropriately responding to a rash following strep throat treatment, you can prevent potentially serious complications while ensuring adequate treatment of the underlying streptococcal infection.