Scarlet Fever - Treatment and complications

Authored by Dr Oliver Starr, 03 May 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Laurence Knott, 03 May 2017

Because scarlet fever is caused by a germ (bacterium) and can cause serious complications without treatment, the best treatment is antibiotics. These take a little time to get to work, so it's also important to give general treatment to relieve symptoms in the meantime.


  • The best antibiotic is penicillin. It almost always kills the scarlet fever germ.
  • You need to take a long course of penicillin: ten days. This is longer than for a simple throat or ear infection and it requires quite a lot of perseverance and organisation to complete the course.
  • The dose will be worked out according to the age and weight of the child, but is likely to be 125-250 mg four times a day, for ten days.
  • If the child is allergic to penicillin then erythromycin or clarithromycin can be used instead.
  • But penicillin is the best for scarlet fever so it's important to check if the child is genuinely allergic to penicillin.

General treatment of a fever

  • It is generally important for anyone who is unwell to keep their fluid levels up.
  • Water alone is fine but a little bit of sugar will help the water to be absorbed. Dilute squash is fine. In a young child, milk is good too.
  • If the child is distressed by the fever - for example, they are limp, drowsy or whimpering - it is worth trying paracetamol.
  • Paracetamol can bring a high temperature (fever) down a little but it does not treat the underlying infection. Note: you should not use paracetamol just to bring down a temperature; it should only be used if the child is really affected by the fever.
  • Too much paracetamol has been shown to be bad for children because having a mild fever can actually help them to fight off the scarlet fever infection.
  • If the child looks OK but has a fever, it is generally best to leave them to have a fever because it can help them fight off the infection.
  • Using paracetamol in children or babies does not reduce the risk of febrile convulsions.
  • You should dress them in clothes that are appropriate for the outside or inside temperature. There is no need to strip down feverish children, fan them, or mop them with wet towels. In studies, none of these treatments has been shown to help.
  • Ibuprofen is generally not recommended in infections that involve the skin.

Generally antibiotics and fluids are the best treatment for scarlet fever.

Treatment with antibiotics reduces the chance of complications. Complications now occur very rarely. However, if they do occur, they can be serious. They can be broadly divided into early complications, which occur within days, and later complications, which happen weeks or months after the infection seems to have gone.

Early complications

Complications due to the spread of the infection can occur early in the infection and may include the following:

  • Ear infection (otitis media).
  • Throat infection and collection of pus (abscess).
  • Sinus infection.
  • Pneumonia.
  • Meningitis and brain abscess.

Later complications

Later complications are rare, but when they do happen problems start weeks, months or even years after the infection has cleared. These occur as a result of immune reactions in the tissues. The body's immune system, rather than the germ itself, are causing the problem. These may include:

This is why it's important to take the full course of antibiotics, even if your child seems to be getting better by themself.

Further reading and references

My son who will be 3 in April has been on antibiotics (not penicillin as his allergic). He also has asthma. His diagnosis GP- after noticing the rash 2 days prior is German measles. He however has...

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