Treatment of scarlet fever

The treatment of choice is penicillin and this leads to the rapid resolution of symptoms in about 24 hours. A ten day course of treatment is necessary to eradicate the streptococci (1).

First choice antibiotic:

• phenoxymethylpenicillin 500mg QDS for 10 days (adult dose) is recommended (3)

If Penicillin allergy: then clarithromycin 250mg to 500mg BD for 5 days (adult dose) is recommended (3)

See BNF for children's doses of antibiotics

Untreated patients may be infectious for up to 2- 3 weeks after the symptoms appear (1).

Paracetamol or ibuprofen can be given to patients for symptomatic relief. Patients should be advised about rest and hydration with plenty of fluids (1).

Inform about the following to patients:

• infection usually clears up after a week and it is no longer a serious illness
• antibiotics are necessary to speed up recovery and to avoid complications
• to take the full course of antibiotics given by the general practitioner
• avoid attending school or work for a minimum of 24 hours after starting treatment
• wash hands frequently
• avoid sharing eating utensils, clothes, bedding and towels with an infected person
• washing or proper disposing of the tissues or handkerchiefs used by an infected person (2)

Reference:

• (1) Marshall S. Scarlet fever : the disease in the UK. The pharmaceutical journal 2006;277
• (2) Health Protection Agency (HPA) 2010. General information – Scarlet fever
• (3) Public Health England (June 2021). Managing common infections: guidance for primary care