Scarlet Fever Treatment & Management

Updated: Nov 06, 2020
  • Author: Bahman Sotoodian, MD; Chief Editor: William D James, MD  more...
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Approach Considerations

The goals in the treatment of scarlet fever are (1) to prevent acute rheumatic fever, (2) to reduce the spread of infection, (3) to prevent poststreptococcal glomerulonephritis and suppurative sequelae (eg, adenitis, mastoiditis, ethmoiditis, abscesses, cellulitis), and (4) to shorten the course of illness.

Antibiotic therapy is the treatment of choice for scarlet fever. Whether antibiotics prevent poststreptococcal glomerulonephritis is still debated in the literature.


Medical Care

Penicillin (or amoxicillin) remains the drug of choice (documented cases of penicillin-resistant group A streptococcal 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, clindamycin or erythromycin may be considered as an alternative. [25, 26]  However, some strains of group A streptococci may not be susceptible to macrolides. [27] Hence, in this situation, it is crucial to contact the microbiology laboratory with regard to the sensitivity of the organism to macrolide antibiotics. A 10- to 14-day course of treatment is usually recommended, and clinical improvement should be noted after 24-48 hours of antibiotic initiation.

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.

If odynophagia accompanying streptococcal pharyngitis is especially severe, hospitalization may be warranted for intravenous hydration and antibiotics.



At this time, a vaccine for group A streptococci does not exist. [28]  To minimize contagion, children with scarlet fever should not return to school or daycare until they have completed 24 hours of antibiotic therapy and are clinically improving. 

Hand hygiene and proper maintenance of environmental hygiene should be highly reinforced. 



If the diagnosis is unclear, consultation with a dermatologist is recommended. For serious complications, an infectious disease specialist should be consulted. Referral to an otolaryngologist for tonsillectomy may be recommended for patients with recurrent pharyngitis.


Long-Term Monitoring

Follow-up evaluation is recommended to ensure resolution of the primary infection. Some patients report pruritus associated with the desquamating rash. Oral antihistamines and emollients usually are sufficient to control the pruritus.