eMedicine Specialties > Emergency Medicine > Infectious Diseases

Scarlet Fever: Treatment & Medication

Author: Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. Barnabas Hospital
Coauthor(s): Daniel P Lombardi, DO, Clinical Assistant Professor, New York College of Osteopathic Medicine; Clinical Preceptor, Albert Einstein College of Medicine of Yeshiva University; Attending Physician and Interim Program Director, Department of Emergency Medicine, Saint Barnabas Hospital
Contributor Information and Disclosures

Updated: May 7, 2009

Treatment

Emergency Department Care

  • The goals when treating scarlet fever are to (1) prevent acute rheumatic fever, (2) reduce the spread of infection, (3) prevent suppurative complications, and (4) shorten the course of illness.
  • Penicillin remains the drug of choice (documented cases of penicillin-resistant group A streptococci infections still do not exist). A first-generation cephalosporin may be an effective alternative, as long as the patient does not have any documented anaphylactic reactions to penicillin. If this is the case, erythromycin can be considered as an alternative.3,4

Consultations

Consult infectious disease specialists for serious complications.

Referral to an ENT specialist may be warranted for recurrent pharyngitis.

Medication

Treatment is aimed at providing adequate antistreptococcal antibiotic levels for at least 10 days.

The mainstay of treatment includes penicillin and erythromycin.

Tetracyclines and sulfonamides should not be used.

Antibiotics

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


Penicillin VK (Veetids, Beepen-VK)

Inhibits biosynthesis of cell wall peptidoglycan and is effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Adult

250 mg PO tid/qid for 10 d

Pediatric

<12 years: 25-50 mg/kg/d PO divided tid/qid; not to exceed 3 g/d
>12 years: Administer as in adults

Probenecid can increase penicillin effectiveness by decreasing its clearance; concurrent administration of tetracyclines can decrease penicillin effectiveness

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Caution with impaired renal function


Penicillin G benzathine (Bicillin L-A)

Interferes with synthesis of cell wall peptidoglycan during active multiplication, resulting in bactericidal activity against susceptible bacteria.

Adult

1.2 million U IM

Pediatric

<27 kg: 600,000 U IM
>27 kg: Administer as in adults

Probenecid can increase penicillin effectiveness by decreasing its clearance; concurrent administration of tetracyclines can decrease penicillin effectiveness

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Caution with impaired renal function


Erythromycin (EES, E-Mycin, Ery-Tab)

Treatment of infections caused by susceptible strains, including streptococci.

Adult

250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) q6h 1 h PO ac or 500 mg PO q12h
Alternatively: 333 mg PO q8h; increase up to 4 g/d, depending on severity of infection
Bid dosing: 500 mg PO q12h (recommended dose); bid dosing not recommended with doses >1 g/d

Pediatric

30-50 mg/kg/d (15-25 mg/lb/d) PO in divided doses for 10 d (age, weight, and severity of infection determine proper dosage)
If bid dosing desired, one half of total daily dose may be taken q12h; not to exceed 1 g/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

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

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

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. Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. Mar 24 2009;119(11):1541-51. [Medline]. [Full Text].

  2. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev. Jul 2004;17(3):571-80, table of contents. [Medline].

  3. Bass JW. Antibiotic management of group A streptococcal pharyngotonsillitis. Pediatr Infect Dis J. Oct 1991;10(10 Suppl):S43-9. [Medline].

  4. Derrick CW, Dillon HC. Erythromycin therapy for streptococcal pharyngitis. Am J Dis Child. Feb 1976;130(2):175-8. [Medline].

  5. Gidaris D, Zafeiriou D, Mavridis P, Gombakis N. Scarlet Fever and hepatitis: a case report. Hippokratia. Jul 2008;12(3):186-7. [Medline].

  6. Reddy UP, Albini TA, Banta JT, Davis JL. Post-streptococcal vasculitis. Ocul Immunol Inflamm. Jan-Feb 2008;16(1):35-6. [Medline].

  7. 2006 Report of the Committee on Infectious Diseases. Summaries of Infectious Diseases. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book. 27th ed. American Academy of Pediatrics; 2006:610-618.

  8. Bialecki C, Feder HM Jr, Grant-Kels JM. The six classic childhood exanthems: a review and update. J Am Acad Dermatol. Nov 1989;21(5 Pt 1):891-903. [Medline].

  9. Burns JC, Kushner HI, Bastian JF, et al. Kawasaki disease: A brief history. Pediatrics. Aug 2000;106(2):E27. [Medline].

  10. Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Pediatrics. Oct 1995;96(4 Pt 1):758-64. [Medline].

  11. Danjani AS, Bisno AL, Chung KJ, et al. Prevention of rheumatic fever. A statement for health professionals by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Circulation. Oct 1988;78(4):1082-6. [Medline].

  12. Del Castillo LD, Macaset T, Olsen J. Group A streptococcal pharyngitis and scarlatiniform rash in an 8-week-old infant. Am J Emerg Med. Mar 2000;18(2):233-4. [Medline].

  13. Duncan SR, Scott S, Duncan CJ. Modelling the dynamics of scarlet fever epidemics in the 19th century. Eur J Epidemiol. 2000;16(7):619-26. [Medline].

  14. Facklam RR. Specificity study of kits for detection of group A streptococci directly from throat swabs. J Clin Microbiol. Mar 1987;25(3):504-8. [Medline].

  15. Hoebe CJ, Wagenvoort JH, Schellekens JF. [An outbreak of scarlet fever, impetigo and pharyngitis caused by the same Streptococcus pyogenes type T4M4 in a primary school]. Ned Tijdschr Geneeskd. Nov 4 2000;144(45):2148-52. [Medline].

  16. Hubalek Z. North Atlantic weather oscillation and human infectious diseases in the Czech Republic, 1951-2003. Eur J Epidemiol. 2005;20(3):263-70. [Medline].

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  18. Katz AR, Morens DM. Severe streptococcal infections in historical perspective. Clin Infect Dis. Jan 1992;14(1):298-307. [Medline].

  19. Quinn RW. Comprehensive review of morbidity and mortality trends for rheumatic fever, streptococcal disease, and scarlet fever: the decline of rheumatic fever. Rev Infect Dis. Nov-Dec 1989;11(6):928-53. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel P Lombardi, DO, Clinical Assistant Professor, New York College of Osteopathic Medicine; Clinical Preceptor, Albert Einstein College of Medicine of Yeshiva University; Attending Physician and Interim Program Director, Department of Emergency Medicine, Saint Barnabas Hospital
Daniel P Lombardi, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone, III, MD, Associate Professor, Department of Emergency Medicine, Truman Medical Center, University of Missouri at Kansas City School of Medicine
Joseph A Salomone, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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