# Scarlet Fever - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Guideline: Scarlet fever 2022 · Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph) · Egyptian National Drug Formulary, antimicrobial 2023, amoxicillin monograph, paediatric dosing · Egyptian National Drug Formulary, antimicrobial 2023, azithromycin monograph, paediatric dosing · Scarlet Fever - disease-level clinical article (scarlet-fever-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (phenoxymethylpenicillin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (penicillin G benzathine monograph, group A streptococcal pharyngitis) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary, antimicrobial 2023, amoxicillin monograph, paediatric dosing - Egyptian National Drug Formulary, antimicrobial 2023, azithromycin monograph, paediatric dosing - Scarlet Fever - disease-level clinical article (scarlet-fever-full.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (phenoxymethylpenicillin monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (penicillin G benzathine monograph, group A streptococcal pharyngitis) ## Treatment metadata - Amoxicillin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Phenoxymethyl penicillin — 500 mg — oral.solid - Penicillin G benzathine — injection - Azithromycin — 500 mg — oral.solid - Clindamycin — 150 mg — oral.solid ## Complete treatment card ```text SCARLET FEVER Sources: NICE Guideline: Scarlet fever 2022 · Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph) · Egyptian National Drug Formulary, antimicrobial 2023, amoxicillin monograph, paediatric dosing · Egyptian National Drug Formulary, antimicrobial 2023, azithromycin monograph, paediatric dosing · Scarlet Fever - disease-level clinical article (scarlet-fever-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (phenoxymethylpenicillin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (penicillin G benzathine monograph, group A streptococcal pharyngitis) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Sudden fever and sore throat are the leading complaints [fever · sore throat] - A headache, perioral flushing, nausea, chills, throwing up, and belly pain can round out the picture [abdominal pain · chills · headache · nausea · vomiting] - Cough, red eyes, runny nose, vomiting, or diarrhoea point more toward a viral cause than strep [cough · diarrhoea · runny nose · vomiting] - Close contact with a strep infection, especially among schoolchildren or in shared living settings, is a useful history clue SIGNS - what you find (8) - Strep throat shows generalised tonsil and pharyngeal redness, variable exudate, a red swollen uvula, and palatal petechiae [petechiae · redness] - Tender cervical lymph nodes are commonly palpable - A fine blanching maculopapular rash together with a strawberry tongue is highly suggestive of scarlet fever [fever · rash] - It begins over the torso, armpits, and groin before spreading further, sparing the palms and soles - Circumoral pallor gives a pale ring around the mouth against the flushed face [pallor] - The tongue first has a white coating with prominent papillae, then turns red and strawberry- like once the coating sheds - Pastia lines are linear papular streaks in skin folds such as the neck, elbow crease, and groin [papules] - Skin peeling can follow the rash and last up to two weeks [rash] TESTS (6) - The Centor score uses tonsillar exudate, tender front neck nodes, no cough, and fever over 38 C, and 3 or more points is highly specific for strep - Throat culture on sheep blood agar remains the gold standard for identifying group A strep - Culture results usually take at least 24 hours, which can delay treatment decisions - A rapid antigen test runs about 85 percent sensitive and 95 percent specific in children - A negative rapid test in adults, who have a lower pretest probability, usually needs no confirmatory culture - Gram stain and culture identify strep from skin, blood, wound, or lung sites when pharyngitis is not the source IF NOT THIS - what else fits (5) - Strawberry tongue and Pastia lines are the strongest clues pointing specifically toward scarlet fever - Rubella, rubeola, EBV or CMV mononucleosis, and parvovirus B19 are viral causes of a similar rash - Varicella, Coxsackievirus hand-foot-mouth disease, and Arcanobacterium haemolyticum are also on the list - Kawasaki disease, toxic shock syndrome, and staphylococcal scalded skin syndrome are important mimics - Other viral rashes such as measles and parvovirus, plus drug reactions, round out the list Source StatPearls "Scarlet Fever" - disease-level clinical article Status traced to the source above Rx: Main treatment | Single IM dose - when an oral course may not be completed | Penicillin allergy MAIN TREATMENT - choose one 1. AMOXICILLIN [1st line] Adult 500 mg twice daily or 1 g once daily x 10 days Peds 20-40 mg/kg/day [child max 1500 mg] (20-40 mg/kg/day divided every 8 hours, no single dose above 500 mg, for 10 days.) 3kg -> 60-120 mg/day 4kg -> 80-160 mg/day 5kg -> 100-200 mg/day 6kg -> 120-240 mg/day 7kg -> 140-280 mg/day 8kg -> 160-320 mg/day 9kg -> 180-360 mg/day 10kg -> 200-400 mg/day 11kg -> 220-440 mg/day 12kg -> 240-480 mg/day 13kg -> 260-520 mg/day 14kg -> 280-560 mg/day 15kg -> 300-600 mg/day 16kg -> 320-640 mg/day 17kg -> 340-680 mg/day 18kg -> 360-720 mg/day 19kg -> 380-760 mg/day 20kg -> 400-800 mg/day 21kg -> 420-840 mg/day 22kg -> 440-880 mg/day 23kg -> 460-920 mg/day 24kg -> 480-960 mg/day 25kg -> 500-1000 mg/day 26kg -> 520-1040 mg/day 27kg -> 540-1080 mg/day 28kg -> 560-1120 mg/day 29kg -> 580-1160 mg/day 30kg -> 600-1200 mg/day 31kg -> 620-1240 mg/day 32kg -> 640-1280 mg/day 33kg -> 660-1320 mg/day 34kg -> 680-1360 mg/day 35kg -> 700-1400 mg/day 36kg -> 720-1440 mg/day 37kg -> 740-1480 mg/day 38kg -> 760-1500 mg/day (upper capped) 39kg -> 780-1500 mg/day (upper capped) 40kg -> 800-1500 mg/day (upper capped) 41kg -> 820-1500 mg/day (upper capped) 42kg -> 840-1500 mg/day (upper capped) 43kg -> 860-1500 mg/day (upper capped) 44kg -> 880-1500 mg/day (upper capped) 45kg -> 900-1500 mg/day (upper capped) 46kg -> 920-1500 mg/day (upper capped) 47kg -> 940-1500 mg/day (upper capped) 48kg -> 960-1500 mg/day (upper capped) 49kg -> 980-1500 mg/day (upper capped) 50kg -> 1000-1500 mg/day (upper capped) Choice Alternatives. The disease article names penicillin V or amoxicillin for 10 days as co- equal oral regimens and states no preference between them; amoxicillin stays the printed default because it was already this card's first-line choice, and the palatable suspension suits the age group scarlet fever mostly affects. Source Egyptian National Drug Formulary, antimicrobial 2023, amoxicillin monograph, paediatric dosing Why Amoxicillin is preferred over phenoxymethylpenicillin suspension in children due to superior palatability Caution MUST COMPLETE FULL 10-DAY COURSE to prevent acute rheumatic fever and post-streptococcal glomerulonephritis. Patient remains infectious until 24 hours after starting antibiotics. Contraindicated in penicillin allergy. Per day, not per dose. Read as a per-dose figure, 12.5-25 mg/kg at three doses a day reaches 75 mg/kg/day - nearly double the formulary's 40 mg/kg/day ceiling for an infection of this severity. Egypt AMOXYCILLIN 500MG 10 CAPS B.P.2013 ARAB DRUG COMPANY (ADCO) 6.50 EGP (0.65/unit) AMOXICILLIN 500MG 12 CAPS. USP 28 OCTOBER PHARMA 8.10 EGP (0.67/unit) AMOXIL 500MG 12 CAPS. MUP > SMITHKL... 9.00 EGP (0.75/unit) AMOXICID 500 MG 12 CAPS. CID 9.50 EGP (0.79/unit) E-MOX 500 MG 16 CAPS. EIPICO 15.60 EGP (0.97/unit) HICONCIL 500MG 12 CAPS. PHARCO 11.60 EGP (0.97/unit) BIOMOX 500MG 12 CAPS. SEDICO 19.50 EGP (1.62/unit) IBIAMOX 500 MG 12 CAPS. AMOUN 45.00 EGP (3.75/unit) HICILLIN 125MG/5ML SUSP. 80ML EL NASR 3.00 EGP -> ? strength differs, ? different route - not oral solid AMOXIL FORT 250MG/5ML SUSP. 60ML MUP > SMITHKL... 5.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Scarlet Fever - disease-level clinical article (scarlet-fever-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Hospitalization is indicated for severe or invasive infection or complications (abscess, toxic shock syndrome, necrotizing fasciitis), or inability to tolerate oral therapy. 3. PHENOXYMETHYL PENICILLIN [1st line] Adult 500 mg 2 to 3 times daily x 10 days Peds 25-50 mg/kg/day [child max 2000 mg] (ENDF general paediatric dosing: 25 to 50 mg/kg/day in divided doses every 6 hours, maximum 2,000 mg/day. For group A streptococcal pharyngitis the ENDF gives 250 mg 2 to 3 times daily under 27 kg and 500 mg 2 to 3 times daily at 27 kg and above, for 10 days.) 3kg -> 75-150 mg/day 4kg -> 100-200 mg/day 5kg -> 125-250 mg/day 6kg -> 150-300 mg/day 7kg -> 175-350 mg/day 8kg -> 200-400 mg/day 9kg -> 225-450 mg/day 10kg -> 250-500 mg/day 11kg -> 275-550 mg/day 12kg -> 300-600 mg/day 13kg -> 325-650 mg/day 14kg -> 350-700 mg/day 15kg -> 375-750 mg/day 16kg -> 400-800 mg/day 17kg -> 425-850 mg/day 18kg -> 450-900 mg/day 19kg -> 475-950 mg/day 20kg -> 500-1000 mg/day 21kg -> 525-1050 mg/day 22kg -> 550-1100 mg/day 23kg -> 575-1150 mg/day 24kg -> 600-1200 mg/day 25kg -> 625-1250 mg/day 26kg -> 650-1300 mg/day 27kg -> 675-1350 mg/day 28kg -> 700-1400 mg/day 29kg -> 725-1450 mg/day 30kg -> 750-1500 mg/day 31kg -> 775-1550 mg/day 32kg -> 800-1600 mg/day 33kg -> 825-1650 mg/day 34kg -> 850-1700 mg/day 35kg -> 875-1750 mg/day 36kg -> 900-1800 mg/day 37kg -> 925-1850 mg/day 38kg -> 950-1900 mg/day 39kg -> 975-1950 mg/day 40kg -> 1000-2000 mg/day 41kg -> 1025-2000 mg/day (upper capped) 42kg -> 1050-2000 mg/day (upper capped) 43kg -> 1075-2000 mg/day (upper capped) 44kg -> 1100-2000 mg/day (upper capped) 45kg -> 1125-2000 mg/day (upper capped) 46kg -> 1150-2000 mg/day (upper capped) 47kg -> 1175-2000 mg/day (upper capped) 48kg -> 1200-2000 mg/day (upper capped) 49kg -> 1225-2000 mg/day (upper capped) 50kg -> 1250-2000 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (phenoxymethylpenicillin monograph) Why Scarlet fever is group A streptococcal disease; the ENDF gives penicillin V a group-A- streptococcus pharyngitis regimen, and the disease article calls oral penicillin V co- first-line with amoxicillin. Caution Known hypersensitivity to any penicillin Egypt OSPEN 1.0 MIU 12 F.C.TABS. SANDOZ 24.00 EGP (2.00/unit) -> ? strength differs OSPEN 1.5 MIU 12 F.C.TABS. SANDOZ 41.00 EGP (3.42/unit) -> ? strength differs 4. AZITHROMYCIN [2nd line] Adult 500 mg on day 1, followed by 250 mg once daily on days 2 through 5 x 5 days Peds 10-12 mg/kg once on day 1 (max 500 mg), then 5-6 mg/kg once daily (max 250 mg) for the rest of the course. It steps down - it is not the same dose every day. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary, antimicrobial 2023, azithromycin monograph, paediatric dosing Why First-line alternative in penicillin-allergic patients Caution Monitor for macrolide resistance and QT prolongation. The weight fields are deliberately empty. A flat mg/kg card cannot express a day-1 dose followed by a lower maintenance dose, and when it tried, it printed the day-1 figure for all five days - double what the child should get from day 2 onward. Azithromycin is second-line for penicillin-allergic patients. Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 21.50 EGP (7.17/unit) AZITHROMASH 500 MG 3 F.C. TABS. MASH PREMIERE 48.00 EGP (16.00/unit) AZALIDE 500MG 3 CAPS. UP PHARMA 52.00 EGP (17.33/unit) AZROLID 500 MG 6 F.C.TABS. AMRIYA 126.00 EGP (21.00/unit) ZERAMERATE 500 MG EGPI > GAMMA ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid SINGLE IM DOSE - WHEN AN ORAL COURSE MAY NOT BE COMPLETED 5. PENICILLIN G BENZATHINE [1st line] Adult IM: 1.2 million units as a single dose - Single dose Peds ENDF, group A streptococcal pharyngitis: children 27 kg or less, 600,000 units IM as a single dose; over 27 kg, 1.2 million units IM as a single dose. Source Egyptian National Drug Formulary - Antimicrobial 2023 (penicillin G benzathine monograph, group A streptococcal pharyngitis) Why Scarlet fever is group A streptococcal disease, and the ENDF gives penicillin G benzathine an explicit group A streptococcal pharyngitis regimen. The disease article offers it for the patient who may not complete a full oral course. Caution Hypersensitivity to penicillin(s) or any component of the formulation The ENDF notes that empiric treatment is generally not recommended and that treatment should be prescribed only when testing confirms group A Streptococcus. Penicillin G benzathine is for intramuscular use only - never give intravenously. Egypt HAYA BENZ-R 1.2 M.I.U. VIAL FOR I.M INJ. SEDICO > HAYA PHARM-EGYPT 5.06 EGP PENICID LA 1 200 000 UNITS VIAL CID 6.50 EGP BENZACILLIN 1.2 M.I.U.FOR I.M.INJ VIAL. EL NASR 7.00 EGP RETARPEN 1.2 M.I.U. VIAL SANDOZ > OCTO... 10.50 EGP LASTIPEN 1 200 000 IU VIAL MISR 12.00 EGP BENZABIOTIC 1.2 M.I.U. I.M. VIAL. SEDICO 16.00 EGP DEPO-PEN 1.2 MIU VIAL. MUP 25.00 EGP PENCILONG (PENCITARD) 1200000 I.U./VIAL NCPC NORTH BEST CO > ACDIMA INTE... 25.00 EGP PENICILLIN ALLERGY 6. CLINDAMYCIN [2nd line] Adult 150 to 300 mg every 6 hours Peds 8-20 mg/kg/day (ENDF oral paediatric dosing, hydrochloride salt (capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours.) 3kg -> 24-60 mg/day 4kg -> 32-80 mg/day 5kg -> 40-100 mg/day 6kg -> 48-120 mg/day 7kg -> 56-140 mg/day 8kg -> 64-160 mg/day 9kg -> 72-180 mg/day 10kg -> 80-200 mg/day 11kg -> 88-220 mg/day 12kg -> 96-240 mg/day 13kg -> 104-260 mg/day 14kg -> 112-280 mg/day 15kg -> 120-300 mg/day 16kg -> 128-320 mg/day 17kg -> 136-340 mg/day 18kg -> 144-360 mg/day 19kg -> 152-380 mg/day 20kg -> 160-400 mg/day 21kg -> 168-420 mg/day 22kg -> 176-440 mg/day 23kg -> 184-460 mg/day 24kg -> 192-480 mg/day 25kg -> 200-500 mg/day 26kg -> 208-520 mg/day 27kg -> 216-540 mg/day 28kg -> 224-560 mg/day 29kg -> 232-580 mg/day 30kg -> 240-600 mg/day 31kg -> 248-620 mg/day 32kg -> 256-640 mg/day 33kg -> 264-660 mg/day 34kg -> 272-680 mg/day 35kg -> 280-700 mg/day 36kg -> 288-720 mg/day 37kg -> 296-740 mg/day 38kg -> 304-760 mg/day 39kg -> 312-780 mg/day 40kg -> 320-800 mg/day 41kg -> 328-820 mg/day 42kg -> 336-840 mg/day 43kg -> 344-860 mg/day 44kg -> 352-880 mg/day 45kg -> 360-900 mg/day 46kg -> 368-920 mg/day 47kg -> 376-940 mg/day 48kg -> 384-960 mg/day 49kg -> 392-980 mg/day 50kg -> 400-1000 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) Why The disease article names clindamycin as the alternative for penicillin-allergic patients; the card's only non-penicillin option was azithromycin. Caution Hypersensitivity to clindamycin, lincomycin, or any component of the formulation The ENDF clindamycin monograph does not list pharyngitis among its indications and gives a general oral range rather than a group A streptococcal course - the indication and the need for a full 10-day course come from the disease article. Egypt ADCOCLINDACE 150 MG 16 CAPS. ARAB DRUG COM... 14.50 EGP (0.91/unit) ALFACLINDAMYCIN 150 MG 10 CAPS. ATCO PHARMA >... 14.50 EGP (1.45/unit) CLINACYN 150MG 16 CAPS. SIGMA > EGYPT... 24.00 EGP (1.50/unit) CLINDAM 150 MG 16 CAPS. SIGMA > OCTOB... 28.50 EGP (1.78/unit) CLINDACINE ART 150MG 12 CAPS. ART PHARMA 27.50 EGP (2.29/unit) MEPACLIND 150MG 16 CAPS. MEPACO 48.00 EGP (3.00/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)