# Erythema Infectiosum (Fifth Disease) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC Parvovirus B19 Guidance · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text ERYTHEMA INFECTIOSUM (FIFTH DISEASE) Sources: CDC Parvovirus B19 Guidance · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) 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 (7) - The illness often starts with fever, tiredness, muscle aches, diarrhea, vomiting, and headache [diarrhoea · fatigue · fever · headache · muscle pain · vomiting] - Joint aches are more common in adults than children, and women report them more than men [joint pain] - Sun or heat exposure can flare the rash [rash] - It is a febrile illness of children aged 5 to 15, and adults catch it too but less often [fever] - Parvovirus B19 is the cause, and the same virus lies behind aplastic anaemia, polyarthropathy and hydrops fetalis [anaemia · hydrops fetalis] - Red flag: in pregnancy a transient aplastic crisis or hydrops fetalis needs special consideration [hydrops fetalis] - It travels mainly on respiratory droplets, can also travel in the blood, and clusters in spring and early summer SIGNS - what you find (7) - A bright red rash covers both cheeks with a pale ring around the mouth [pallor · rash] - The facial rash typically lasts 4 to 5 days [rash] - The trunk and limb rash can fade into a lace-like pattern on extensor surfaces and spares the palms and soles [rash] - Joint involvement is usually symmetric, affecting the hands, feet, wrists, knees, and elbows - Immunocompromised patients often lack the typical rash or joint findings - The child is no longer contagious once the rash appears [rash] - The rash moves through 3 distinct phases on the skin [rash] TESTS (4) - IgM antibodies confirm a recent infection, appearing 7 to 10 days after exposure - IgG antibodies rise about 2 weeks after exposure and indicate lasting immunity - Antibody testing helps confirm parvovirus B19 as the cause of an aplastic crisis - IgG testing in pregnancy checks immunity status and risk to the fetus IF NOT THIS - what else fits (4) - Other viral rashes to distinguish include measles, rubella, roseola, and scarlet fever - In adults with joint pain, influenza and mononucleosis should also be considered - Drug hypersensitivity reactions, rheumatoid arthritis, and juvenile idiopathic arthritis are also on the differential - Joint-disease diagnoses become unlikely once the pain and stiffness resolve, typically by 3 weeks Source StatPearls "Erythema Infectiosum" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (max. 4 g daily) Peds 15 mg/kg/dose [child max 500 mg] (Give 15 mg/kg every 4-6 hours as needed (max 60 mg/kg/day) Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Antipyretic and analgesic for the fever and joint discomfort of erythema infectiosum, a self-limiting viral illness; it does not treat the underlying viral infection itself. Caution Benign self-limiting viral rash in children; patient is NO LONGER CONTAGIOUS once rash appears. PREGNANCY ALERT: Parvovirus B19 causes hydrops fetalis and fetal loss in pregnant women; urgent obstetric referral required. There is an aplastic crisis risk in patients with chronic haemolytic anaemia (sickle cell, thalassaemia, spherocytosis). 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Administer with caution to patients with hepatic impairment. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [add-on - not a substitute] Adult 400 mg every 8 hours with food as needed for joint pain Peds 5-6.67 mg/kg/dose [child max 400 mg] (Give 5-10 mg/kg 3 times daily with food for symptomatic arthralgia. Daily ceiling: the suspension's own label caps pain- and-fever use at 20 mg/kg/day, while the reference literature allows up to 40. Stay near 20 unless there is a reason to climb, never exceed 400 mg in a single dose, and note that 30-40 mg/kg/day is the juvenile arthritis range rather than an analgesic one.) 3kg -> 15-20 mg/dose 4kg -> 20-26.7 mg/dose 5kg -> 25-33.4 mg/dose 6kg -> 30-40 mg/dose 7kg -> 35-46.7 mg/dose 8kg -> 40-53.4 mg/dose 9kg -> 45-60 mg/dose 10kg -> 50-66.7 mg/dose 11kg -> 55-73.4 mg/dose 12kg -> 60-80 mg/dose 13kg -> 65-86.7 mg/dose 14kg -> 70-93.4 mg/dose 15kg -> 75-100 mg/dose 16kg -> 80-106.7 mg/dose 17kg -> 85-113.4 mg/dose 18kg -> 90-120.1 mg/dose 19kg -> 95-126.7 mg/dose 20kg -> 100-133.4 mg/dose 21kg -> 105-140.1 mg/dose 22kg -> 110-146.7 mg/dose 23kg -> 115-153.4 mg/dose 24kg -> 120-160.1 mg/dose 25kg -> 125-166.8 mg/dose 26kg -> 130-173.4 mg/dose 27kg -> 135-180.1 mg/dose 28kg -> 140-186.8 mg/dose 29kg -> 145-193.4 mg/dose 30kg -> 150-200.1 mg/dose 31kg -> 155-206.8 mg/dose 32kg -> 160-213.4 mg/dose 33kg -> 165-220.1 mg/dose 34kg -> 170-226.8 mg/dose 35kg -> 175-233.4 mg/dose 36kg -> 180-240.1 mg/dose 37kg -> 185-246.8 mg/dose 38kg -> 190-253.5 mg/dose 39kg -> 195-260.1 mg/dose 40kg -> 200-266.8 mg/dose 41kg -> 205-273.5 mg/dose 42kg -> 210-280.1 mg/dose 43kg -> 215-286.8 mg/dose 44kg -> 220-293.5 mg/dose 45kg -> 225-300.1 mg/dose 46kg -> 230-306.8 mg/dose 47kg -> 235-313.5 mg/dose 48kg -> 240-320.2 mg/dose 49kg -> 245-326.8 mg/dose 50kg -> 250-333.5 mg/dose Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) Why Adjunct NSAID added for the polyarthropathy that the causative virus frequently produces in post-pubertal females, giving anti-inflammatory pain relief on top of paracetamol. Caution Useful for post-pubertal females who frequently develop polyarthropathy with Parvovirus B19. Take with food. The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it. Contraindicated in the last trimester of pregnancy. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 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)