Scarlet Fever Medication
- Author: Bahman Sotoodian, MD; Chief Editor: William D James, MD more...
Treatment is aimed at providing adequate antistreptococcal antibiotic levels for at least 10 days.
Treat patients who have scarlet fever with a standard 10-day course of oral penicillin VK or erythromycin. Patients can also be treated with a single intramuscular injection of penicillin G benzathine. These regimens may prevent acute renal failure if antibiotics are initiated within 1 week of the onset of acute pharyngitis. First-generation cephalosporins may also be used. Erythromycin should be considered in patients allergic to penicillin. Tetracyclines and sulfonamides should not be used.
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Penicillin G interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity.
Penicillin VK is the drug of choice. It inhibits biosynthesis of cell wall mucopeptides and is effective during active multiplication. Inadequate concentrations may produce only bacteriostatic effects.
Amoxicillin is an alternative drug of choice. It interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Erythromycin is the drug of choice in penicillin-allergic patients. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for treatment of infections caused by susceptible strains, including streptococci.
In children, age, weight, and severity of infection determine proper dosage. When twice-daily dosing is desired, half of the total daily dose may be taken every 12 hours. For more severe infections, double the dose.
Cephalexin is an alternative drug of choice. It is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. Its primary activity is against skin flora; it is used for skin infections.
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