Scarlet Fever Treatment
Penicillin V (phenoxymethylpenicillin) is the first-line treatment for scarlet fever at a dose of 250-500 mg every 6-8 hours for 10 days for adults and children 12 years and over. 1, 2
First-Line Treatment Options
- Oral Penicillin V is the drug of choice for scarlet fever treatment as recommended by the American Heart Association and the Infectious Diseases Society of America 1
- For adults and children 12 years and over: 250-500 mg (400,000-800,000 units) every 6-8 hours for 10 days 2
- The full 10-day course must be completed even if symptoms improve before completion to prevent complications and reduce contagiousness 1, 3
Alternative Treatment Options for Penicillin-Allergic Patients
- First-generation cephalosporins (e.g., cephalexin) are recommended for patients without immediate hypersensitivity to β-lactam antibiotics 1
- Macrolides (e.g., erythromycin, clarithromycin) are recommended for patients with true penicillin allergy 1
- When considering alternatives, be aware that some strains of Streptococcus pyogenes may be resistant to macrolides 4
Clinical Monitoring and Follow-up
- Monitor for clinical improvement within 48-72 hours of starting antibiotics 1
- If symptoms persist beyond 3-5 days of antibiotic therapy, reassess the diagnosis and consider alternative pathogens 1
- Clinical follow-up is recommended to ensure resolution of symptoms 1
- Post-treatment throat cultures are not routinely recommended unless symptoms persist or recur 1
Management of Close Contacts
- Routine throat cultures or treatment for asymptomatic household contacts is generally not necessary 1
- In outbreak situations, throat cultures should be performed for all patients and only those with positive throat cultures should be treated 1
Supportive Care
- Antipyretics may be used for symptomatic relief of fever but do not replace the need for antibiotics 1
- Adequate hydration and rest are important supportive measures 3
Importance of Early Treatment
- Early antibiotic treatment is essential to reduce the risk of complications including acute rheumatic fever, glomerulonephritis, bacteremia, pneumonia, endocarditis, and meningitis 5, 6
- Prompt treatment also reduces the period of contagiousness, limiting spread in settings such as schools and daycares 3, 7
Common Pitfalls and Caveats
- Scarlet fever can present atypically, especially in adults, with unusual rash distribution that may lead to misdiagnosis 8
- The disease has seen a resurgence in recent years, particularly in Europe and the UK, requiring increased vigilance 7, 6
- Despite a general trend toward reducing antibiotic use for mild self-limiting infections, scarlet fever requires antibiotic treatment regardless of severity to prevent complications 7
- Never use aspirin for fever control in children under 16 years due to risk of Reye's syndrome 4