eMedicine Specialties > Dermatology > Bacterial Infections

Scarlet Fever: Treatment & Medication

Author: Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
Contributor Information and Disclosures

Updated: Apr 28, 2009

Treatment

Medical Care

Antibiotic therapy is the treatment of choice for scarlet fever. Cultures should be obtained where organisms other than streptococcal bacteria are suspected. The desquamating rash that follows is self-limited, with only emollients necessary for care.

Consultations

If the diagnosis is unclear, consultation with a dermatologist is recommended.

Medication

DOC is benzathine penicillin G administered IM or penicillin VK administered PO for 10 days. First-generation cephalosporins may also be used. Erythromycin should be considered in patients allergic to penicillin.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.


Penicillin G benzathine (Bicillin LA)

Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity.

Adult

1.2 million U IM administered as single injection

Pediatric

<27 kg: 300,000-600,000 U IM
>27 kg: 900,000-1.2 million U IM

Probenecid can increase penicillin effectiveness by decreasing clearance; coadministration with tetracyclines can decrease effectiveness of penicillin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function


Penicillin VK (Veetids, Beepen-VK)

DOC; inhibits biosynthesis of cell wall mucopeptides and is effective during active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Adult

500 mg PO qid for 10 d

Pediatric

25-50 mg/kg/d PO divided bid/qid for 10 d

Probenecid can increase effects of penicillin by decreasing clearance; coadministration of tetracyclines can decrease effects of penicillin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function


Amoxicillin (Amoxil, Polymox, Trimox)

Alternate DOC; interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.

Adult

250-500 mg PO tid for 10 d

Pediatric

40 mg/kg/d PO divided tid for 10 d

Reduces efficacy of PO contraceptives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment


Erythromycin (E.E.S., E-Mycin, Ery-Tab)

DOC in penicillin-allergic patients. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

Adult

250-500 mg PO qid for 10 d

Pediatric

30-50 mg/kg/d PO divided qid for 10 d

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis

Documented hypersensitivity; hepatic impairment; cisapride, cyclosporine, or warfarin administration, use alternate drug

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; adverse GI effects are common (administer doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occurs


Cephalexin (Keflex, Biocef)

Alternate DOC; first-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora; used for skin infections.

Adult

250-500 mg PO qid for 10 d

Pediatric

25-50 mg/kg/d PO divided qid for 10 d

Coadministration with aminoglycosides increase nephrotoxic potential

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment; causes an allergic reaction in approximately 10% of penicillin-allergic patients

More on Scarlet Fever

Overview: Scarlet Fever
Differential Diagnoses & Workup: Scarlet Fever
Treatment & Medication: Scarlet Fever
Follow-up: Scarlet Fever
Multimedia: Scarlet Fever
References
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References

  1. Dong H, Xu G, Li S, et al. Beta-haemolytic group A streptococci emm75 carrying altered pyrogenic exotoxin A linked to scarlet fever in adults. J Infect. Apr 2008;56(4):261-7. [Medline].

  2. Yang SG, Dong HJ, Li FR, Xie SY, Cao HC, Xia SC, et al. Report and analysis of a scarlet fever outbreak among adults through food-borne transmission in China. J Infect. Nov 2007;55(5):419-24. [Medline].

  3. Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev. Jul 2000;13(3):470-511. [Medline].

  4. Sandrini J, Beucher AB, Kouatchet A, Lavigne C. [Scarlet fever with multisystem organ failure and hypertrophic gastritis.]. Rev Med Interne. May 2009;30(5):456-9. [Medline].

  5. Gomez-Carrasco JA, Lassaletta A, Ruano D. [Acute hepatitis may form part of scarlet fever]. An Pediatr (Barc). Apr 2004;60(4):382-3. [Medline].

  6. Guven A. Hepatitis and hematuria in scarlet fever. Indian J Pediatr. Nov 2002;69(11):985-6. [Medline].

  7. Lau SK, Woo PC, Yuen KY. Toxic scarlet fever complicating cellulitis: early clinical diagnosis is crucial to prevent a fatal outcome. New Microbiol. Apr 2004;27(2):203-6. [Medline].

  8. Leslie DL, Kozma L, Martin A, et al. Neuropsychiatric Disorders Associated With Streptococcal Infection: A Case-Control Study Among Privately Insured Children. J Am Acad Child Adolesc Psychiatry. Aug 21 2008;[Medline].

  9. Gaston DA, Zurowski SM. Arcanobacterium haemolyticum pharyngitis and exanthem. Three case reports and literature review. Arch Dermatol. Jan 1996;132(1):61-4. [Medline].

  10. Sanz JC, Bascones Mde L, Martin F, Saez-Nieto JA. [Recurrent scarlet fever due to recent reinfection caused by strains unrelated to Streptococcus pyogenes.]. Enferm Infecc Microbiol Clin. Jun-Jul 2005;23(6):388-9. [Medline].

  11. Swartz MN, Weinberg AN. Infections due to Gram-Positive Bacteria. In: Dermatology in General Medicine. Vol 2. 4th ed. New York, NY: McGraw-Hill; 1993:2318-20.

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Further Reading

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Contributor Information and Disclosures

Author

Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
Disclosure: Nothing to disclose.

Medical Editor

Craig A Elmets, MD, Director of Dermatology, Departments of Dermatology, Pathology, and Environmental Health Sciences; Professor, The Kirklin Clinic, University of Alabama at Birmingham
Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Palomar Medical Technologies Stock None; Amgen Consulting fee Review panel membership; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis  investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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