What is the recommended treatment for a patient presenting with a Scarlatina rash?

Treatment of Scarlatina (Scarlet Fever)

Immediate treatment with phenoxymethylpenicillin (Penicillin V) is the first-line therapy for scarlatina to prevent complications and reduce transmission. 1

First-Line Antibiotic Treatment

• Phenoxymethylpenicillin (Penicillin V) should be prescribed immediately upon clinical diagnosis without waiting for culture confirmation 1
• Group A Streptococcus (GAS) demonstrates nearly 100% sensitivity to beta-lactam antibiotics, making penicillin highly effective 2
• Treatment duration should be 10 days to ensure eradication of the pathogen and prevent complications 3

Alternative Antibiotics for Penicillin-Allergic Patients

For patients with non-Type I hypersensitivity reactions (e.g., rash):

• First-generation cephalosporins (e.g., cephalexin) are appropriate alternatives 3
• Cefuroxime axetil or cefpodoxime proxetil provide effective coverage 3

For patients with true penicillin allergy (Type I hypersensitivity):

• Erythromycin or other macrolides can be used, though resistance has increased 9-fold in recent years to 1.9% 2
• Clindamycin is an effective alternative 4
• Avoid macrolides if local resistance patterns are high, as cross-resistance to lincosamides can develop 4

Clinical Recognition and Diagnosis

The diagnosis is primarily clinical, based on:

• Distinctive macro-papular rash with sandpaper texture, typically in children 1
• Fever and pharyngitis with characteristic findings 3
• Strawberry tongue and circumoral pallor 3
• Desquamation of fingers and toes occurring 2-3 weeks after fever onset 3

Critical Management Points

• Start antibiotics immediately upon clinical suspicion—do not delay for throat culture results 1
• Identification of beta-hemolytic streptococci through culture confirms diagnosis but should not delay treatment 5
• Treatment reduces complications including rheumatic fever, post-streptococcal glomerulonephritis, and suppurative complications 3
• Antibiotic therapy reduces transmission and allows return to school/work after 24 hours of treatment 1

Monitoring for Complications

• Assess for suppurative complications including peritonsillar abscess, cervical lymphadenitis, and otitis media 3
• Monitor for post-infectious sequelae such as acute rheumatic fever and glomerulonephritis, though antibiotics do not prevent glomerulonephritis 3
• Watch for severe invasive disease including necrotizing fasciitis or toxic shock syndrome, which require immediate hospitalization 3

Special Considerations

• Surgical scarlet fever can occur postoperatively and requires the same penicillin-based treatment 5
• Adults may present with more severe clinical manifestations than children 2
• Recent epidemiological data shows increasing incidence in 7-14 year olds with most cases presenting in primary care 2, 1
• Tetracycline and gentamicin resistance is increasing and these agents should be avoided 2