How should I manage a patient with scarlet fever who presents with severe symptoms or complications?

Management of a patient with scarlet fever presenting with severe symptoms or complications:

• Arrange urgent hospital admission if the patient has severe symptoms that cannot be managed in primary care or if there is a suspected serious or life-threatening complication.
• Consider hospital admission urgently based on clinical judgement, especially for those at high risk of developing complications.
• In hospital, management will include specialist care and may involve intravenous antibiotics and supportive treatments as needed.
• If hospital admission is not required, prescribe appropriate antibiotics promptly: a 10-day course of phenoxymethylpenicillin (penicillin V) is first-line.
• For patients with penicillin allergy, use clarithromycin, azithromycin, or erythromycin depending on age and pregnancy status.
• Notify the local health protection team promptly within 3 days of suspected scarlet fever diagnosis.
• Advise on self-care measures including symptom relief with paracetamol or ibuprofen if no contraindications, adequate fluid intake, and skin care.
• Advise exclusion from nursery, school, or work for at least 24 hours after starting antibiotics to reduce cross-infection risk.
• Maintain a low threshold for prompt referral to secondary care if symptoms worsen or do not improve after 7 days.
• For children with persistent or worsening symptoms, consider urgent referral to paediatric specialist care.

These steps ensure timely specialist management of severe or complicated scarlet fever to reduce morbidity and mortality risks.

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