There has been an increase Group A Streptococcal (GAS) infections in recent months, which has led to at least 8 deaths in children. Although GAS rates are higher than expected for this time of year, they have been higher at periods over the last decade. GAS causes a range of infections including Scarlet Fever and also more severe invasive disease.
For more information on management, see: Scarlet fever: a guide for general practitioners. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319/
The Centor score can be used to assess the probability of an illness being GAS pharyngitis: Tonsillar exudates, tender anterior cervical adenopathy, absence of cough, history of fever (>38 °C). Penicillin V (or Amoxicillin) is the preferred treatment unless contra-indicated in which case an alternative such as a cephalosporin or clarithromycin can be given.
Scarlet Fever and invasive GAS disease are notifiable and should be reported to the local health protection unit. Contacts (although at higher risk of GAS infection) do not generally need antibiotics unless symptomatic. See contact tracing flowchart for details. Health protection teams are responsible for contact tracing.
This guidance was updated in 2008 and may change again.
Antibiotics should only be administered:
1. To mother and baby if either develops invasive group A streptococcal disease in the neonatal period (first 28 days of life);
2. To close contacts if they have symptoms suggestive of localised Group A streptococcal infection, i.e. sore throat, fever, skin infection;
3. To the entire household if there are two or more cases of invasive group A streptococcal disease within a 30 day time period.
Oral Penicillin V is the drug of first choice where chemoprophylaxis is indicated. Azithromycin is a suitable alternative for those allergic to penicillin. Some areas of England are now reporting shortages of liquid antibiotics.