a) Amoxicillin qday for 10 days

c) Penicillin VK BID for 10 days

Scarlet Fever

  • This case is highly suggestive of Scarlet fever
  • Choice of antibiotics for Group A Strep pharyngitis is complicated because of multiple options and ongoing drug shortages
    • For children and young adults who can swallow pills, Penicillin VK is the best option with narrowest spectrum
    • For young children, liquid Penicillin is poorly palatable so Amoxicillin is recommended
      • Note that the Amoxicillin dosing is once daily; while it can be split twice daily, compliance is better with once daily at 50mg/kg/day (max 1 gm). This dosing is not used for otitis media or pneumonia.
    • Benzathine penicillin G IM x 1 dose would be a reasonable choice, however, during any ongoing nationwide shortage this should be reserved for syphilis treatment only
      • Recent shortage was nationwide, not just DHS
    • Azithromycin is a distant second choice and should be used only in patients with PCN allergies documented; cephalexin can also be considered for PCN allergy
    • Amoxicillin/Clavulanate is not indicated as it is overly broad for this indication leading to increased risk of C. difficile

GAS treatment

  1. Clinical Infectious Diseases, Volume 55, Issue 10, 15 November 2012, Pages e86–e102
  2. Clinical Infectious Diseases, Volume 58, Issue 10, 15 May 2014, Pages 1496 (error in table correction)