Dawaa Reference

infectious

Scarlet Fever

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources8 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 against6 documents
  • 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 date2026-08

Presentation reference

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

SourceStatPearls "Scarlet Fever" - disease-level clinical article

Presentation findings are 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

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice daily or 1 g once daily x 10 days

Paediatric dose

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.)

Dose by weight
3kg60-120 mg/day
4kg80-160 mg/day
5kg100-200 mg/day
6kg120-240 mg/day
7kg140-280 mg/day
8kg160-320 mg/day
9kg180-360 mg/day
10kg200-400 mg/day
11kg220-440 mg/day
12kg240-480 mg/day
13kg260-520 mg/day
14kg280-560 mg/day
15kg300-600 mg/day
16kg320-640 mg/day
17kg340-680 mg/day
18kg360-720 mg/day
19kg380-760 mg/day
20kg400-800 mg/day
21kg420-840 mg/day
22kg440-880 mg/day
23kg460-920 mg/day
24kg480-960 mg/day
25kg500-1000 mg/day
26kg520-1040 mg/day
27kg540-1080 mg/day
28kg560-1120 mg/day
29kg580-1160 mg/day
30kg600-1200 mg/day
31kg620-1240 mg/day
32kg640-1280 mg/day
33kg660-1320 mg/day
34kg680-1360 mg/day
35kg700-1400 mg/day
36kg720-1440 mg/day
37kg740-1480 mg/day
38kg760-1500 mg/day (upper capped)
39kg780-1500 mg/day (upper capped)
40kg800-1500 mg/day (upper capped)
41kg820-1500 mg/day (upper capped)
42kg840-1500 mg/day (upper capped)
43kg860-1500 mg/day (upper capped)
44kg880-1500 mg/day (upper capped)
45kg900-1500 mg/day (upper capped)
46kg920-1500 mg/day (upper capped)
47kg940-1500 mg/day (upper capped)
48kg960-1500 mg/day (upper capped)
49kg980-1500 mg/day (upper capped)
50kg1000-1500 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.

Dose source

Egyptian National Drug Formulary, antimicrobial 2023, amoxicillin monograph, paediatric dosing

Why

Amoxicillin is preferred over phenoxymethylpenicillin suspension in children due to superior palatability

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
AMOXYCILLIN 500MG 10 CAPS B.P.2013ARAB DRUG COMPANY (ADCO)6.50 EGP (0.65/unit)
AMOXICILLIN 500MG 12 CAPS. USP 28OCTOBER PHARMA8.10 EGP (0.67/unit)
AMOXIL 500MG 12 CAPS.MUP > SMITHKLINE BEECHAM9.00 EGP (0.75/unit)
AMOXICID 500 MG 12 CAPS.CID9.50 EGP (0.79/unit)
E-MOX 500 MG 16 CAPS.EIPICO15.60 EGP (0.97/unit)
HICONCIL 500MG 12 CAPS.PHARCO11.60 EGP (0.97/unit)
BIOMOX 500MG 12 CAPS.SEDICO19.50 EGP (1.62/unit)
IBIAMOX 500 MG 12 CAPS.AMOUN45.00 EGP (3.75/unit)
HICILLIN 125MG/5ML SUSP. 80ML? strength differs? different route - not oral solidEL NASR3.00 EGP
AMOXIL FORT 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidMUP > SMITHKLINE BEECHAM5.50 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • 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

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg 2 to 3 times daily x 10 days

Paediatric dose

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.)

Dose by weight
3kg75-150 mg/day
4kg100-200 mg/day
5kg125-250 mg/day
6kg150-300 mg/day
7kg175-350 mg/day
8kg200-400 mg/day
9kg225-450 mg/day
10kg250-500 mg/day
11kg275-550 mg/day
12kg300-600 mg/day
13kg325-650 mg/day
14kg350-700 mg/day
15kg375-750 mg/day
16kg400-800 mg/day
17kg425-850 mg/day
18kg450-900 mg/day
19kg475-950 mg/day
20kg500-1000 mg/day
21kg525-1050 mg/day
22kg550-1100 mg/day
23kg575-1150 mg/day
24kg600-1200 mg/day
25kg625-1250 mg/day
26kg650-1300 mg/day
27kg675-1350 mg/day
28kg700-1400 mg/day
29kg725-1450 mg/day
30kg750-1500 mg/day
31kg775-1550 mg/day
32kg800-1600 mg/day
33kg825-1650 mg/day
34kg850-1700 mg/day
35kg875-1750 mg/day
36kg900-1800 mg/day
37kg925-1850 mg/day
38kg950-1900 mg/day
39kg975-1950 mg/day
40kg1000-2000 mg/day
41kg1025-2000 mg/day (upper capped)
42kg1050-2000 mg/day (upper capped)
43kg1075-2000 mg/day (upper capped)
44kg1100-2000 mg/day (upper capped)
45kg1125-2000 mg/day (upper capped)
46kg1150-2000 mg/day (upper capped)
47kg1175-2000 mg/day (upper capped)
48kg1200-2000 mg/day (upper capped)
49kg1225-2000 mg/day (upper capped)
50kg1250-2000 mg/day (upper capped)
Dose 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.

Cautions
  • Known hypersensitivity to any penicillin
Egyptian brands
Egyptian brandManufacturerIndicative price
OSPEN 1.0 MIU 12 F.C.TABS.? strength differsSANDOZ24.00 EGP (2.00/unit)
OSPEN 1.5 MIU 12 F.C.TABS.? strength differsSANDOZ41.00 EGP (3.42/unit)
4

AZITHROMYCIN

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg on day 1, followed by 250 mg once daily on days 2 through 5 x 5 days

Paediatric dose

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.

Dose source

Egyptian National Drug Formulary, antimicrobial 2023, azithromycin monograph, paediatric dosing

Why

First-line alternative in penicillin-allergic patients

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
AZATRIBACT 500MG 3 CAPS.RIVA PHARMA S.A.E.13.50 EGP (4.50/unit)
GIGAZOCIN 500MG 5 CAPS.EGPI > PIONEER27.50 EGP (5.50/unit)
SYSTYMYCIN 500MG 3 CAPS.EGPI > NOVELL PHARMA21.50 EGP (7.17/unit)
AZITHROMASH 500 MG 3 F.C. TABS.MASH PREMIERE48.00 EGP (16.00/unit)
AZALIDE 500MG 3 CAPS.UP PHARMA52.00 EGP (17.33/unit)
AZROLID 500 MG 6 F.C.TABS.AMRIYA126.00 EGP (21.00/unit)
ZERAMERATE 500 MGEGPI > GAMMA PHARMA28.50 EGP
DISTABCIN 500 MG 3 DISPERSIBLE TABS.EGPI43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solidEL-OBOUR > AVERROES PHARMA-EGYPT12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solidORGANO PHARMA > NOVELL PHARMA12.75 EGP

SINGLE IM DOSE - WHEN AN ORAL COURSE MAY NOT BE COMPLETED

5

PENICILLIN G BENZATHINE

Single IM dose - when an oral course may not be completed

1st line

Forminjection

Adult dose and duration

IM: 1.2 million units as a single dose - Single dose

Paediatric dose

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.

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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
HAYA BENZ-R 1.2 M.I.U. VIAL FOR I.M INJ.SEDICO > HAYA PHARM-EGYPT5.06 EGP
PENICID LA 1 200 000 UNITS VIALCID6.50 EGP
BENZACILLIN 1.2 M.I.U.FOR I.M.INJ VIAL.EL NASR7.00 EGP
RETARPEN 1.2 M.I.U. VIALSANDOZ > OCTOBER PHARMA10.50 EGP
LASTIPEN 1 200 000 IU VIALMISR12.00 EGP
BENZABIOTIC 1.2 M.I.U. I.M. VIAL.SEDICO16.00 EGP
DEPO-PEN 1.2 MIU VIAL.MUP25.00 EGP
PENCILONG (PENCITARD) 1200000 I.U./VIALNCPC NORTH BEST CO > ACDIMA INTERNATIONAL TRADING25.00 EGP

PENICILLIN ALLERGY

6

CLINDAMYCIN

Penicillin allergy

2nd line

Strength150 mg

Formoral.solid

Adult dose and duration

150 to 300 mg every 6 hours

Paediatric dose

8-20 mg/kg/day

(ENDF oral paediatric dosing, hydrochloride salt (capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours.)

Dose by weight
3kg24-60 mg/day
4kg32-80 mg/day
5kg40-100 mg/day
6kg48-120 mg/day
7kg56-140 mg/day
8kg64-160 mg/day
9kg72-180 mg/day
10kg80-200 mg/day
11kg88-220 mg/day
12kg96-240 mg/day
13kg104-260 mg/day
14kg112-280 mg/day
15kg120-300 mg/day
16kg128-320 mg/day
17kg136-340 mg/day
18kg144-360 mg/day
19kg152-380 mg/day
20kg160-400 mg/day
21kg168-420 mg/day
22kg176-440 mg/day
23kg184-460 mg/day
24kg192-480 mg/day
25kg200-500 mg/day
26kg208-520 mg/day
27kg216-540 mg/day
28kg224-560 mg/day
29kg232-580 mg/day
30kg240-600 mg/day
31kg248-620 mg/day
32kg256-640 mg/day
33kg264-660 mg/day
34kg272-680 mg/day
35kg280-700 mg/day
36kg288-720 mg/day
37kg296-740 mg/day
38kg304-760 mg/day
39kg312-780 mg/day
40kg320-800 mg/day
41kg328-820 mg/day
42kg336-840 mg/day
43kg344-860 mg/day
44kg352-880 mg/day
45kg360-900 mg/day
46kg368-920 mg/day
47kg376-940 mg/day
48kg384-960 mg/day
49kg392-980 mg/day
50kg400-1000 mg/day
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 150 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)14.50 EGP (0.91/unit)
ALFACLINDAMYCIN 150 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN14.50 EGP (1.45/unit)
CLINACYN 150MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY24.00 EGP (1.50/unit)
CLINDAM 150 MG 16 CAPS.SIGMA > OCTOBER PHARMA28.50 EGP (1.78/unit)
CLINDACINE ART 150MG 12 CAPS.ART PHARMA27.50 EGP (2.29/unit)
MEPACLIND 150MG 16 CAPS.MEPACO48.00 EGP (3.00/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.