Treatment and Management of Scarlet Fever
Penicillin is the drug of choice for scarlet fever treatment, with a full 10-day course required even if symptoms improve earlier to prevent complications such as acute rheumatic fever. 1
Clinical Presentation and Diagnosis
Scarlet fever is a contagious infection primarily affecting children aged 5-15 years, characterized by:
- High-grade fever (101°F-104°F)
- Sore throat
- Distinctive sandpaper-like rash (appears 1-2 days after fever onset)
- Strawberry tongue and oral manifestations
- Tonsillopharyngeal erythema with/without exudates
- Tender, enlarged anterior cervical lymph nodes
Diagnosis is based on clinical presentation and confirmed through:
- Throat culture (gold standard)
- Rapid antigen detection test (RADT) for Group A Streptococcus (GAS)
Antibiotic Treatment Protocol
First-line Treatment:
- Penicillin V (phenoxymethylpenicillin): Complete 10-day oral course 1
- Children: 250 mg 2-3 times daily for 10 days
- Adults: 500 mg 2-3 times daily for 10 days
- Alternative: Single dose of intramuscular benzathine penicillin G 1
For Penicillin-Allergic Patients:
- First or second-generation cephalosporins (if no anaphylactic reaction to penicillin)
- Macrolides (e.g., erythromycin, clarithromycin, azithromycin) 1
- Note: Erythromycin resistance has been reported in some outbreaks 2
Important Considerations:
- Sulfonamides and fluoroquinolones are NOT recommended 1
- Treatment should begin immediately upon clinical diagnosis to reduce complications and transmission 3
- Patients are considered contagious until 24 hours after starting effective antibiotic therapy 1
Supportive Care
- Adequate hydration
- Antipyretics for fever control
- Analgesics for throat pain
- Rest until fever resolves and patient feels better 1
Infection Control Measures
- Isolate patient during first 24 hours of antibiotic treatment
- Frequent handwashing
- Avoid sharing utensils, glasses, or food
- Consider school/daycare exclusion until 24 hours after starting antibiotics 1
Monitoring and Follow-up
- Evaluate clinical response within 48-72 hours of starting treatment
- Consider changing antibiotics if no improvement after 48-72 hours
- Post-treatment cultures are not recommended in uncomplicated cases 1
Potential Complications if Untreated
Untreated scarlet fever can lead to serious complications including:
- Acute rheumatic fever
- Glomerulonephritis
- Bacteremia
- Pneumonia
- Endocarditis
- Meningitis 4
Special Considerations
- The incidence of scarlet fever has increased in recent years in several countries 5, 6
- Early diagnosis and treatment are crucial to prevent complications and reduce transmission
- No vaccine is currently available for scarlet fever 1
- Desquamation of fingers and toes may begin 1-3 weeks after initial symptoms 1
Pitfalls to Avoid
- Failing to complete the full 10-day antibiotic course even if symptoms resolve earlier
- Misdiagnosing as viral infection (consider absence of cough, coryza, hoarseness as clues for scarlet fever)
- Delaying antibiotic treatment, which increases risk of complications and transmission
- Using inappropriate antibiotics like sulfonamides or fluoroquinolones