Group A Streptococcal Infection

Group A Streptococcal Infection (scarlet fever & Invasive Disease) Guidance

We fully appreciate heightened anxiety about Group A Streptococcal Infections spreading in the community. We use guidance on the Healthier Together website (App) and Antibiotic Prescribing Guidelines to make decision about treatment – this is based on the FeverPAIN score:

  1. Fever in the past 24 hours (1)
  2. Absence of cough or Mucus from nose like cold (1)
  3. Symptom onset over less than 3 days (1)
  4. Exudates on tonsils (1)
  5. Severe inflammation of tonsils (1)

We base decision about antibiotic treatment on FeverPAIN score (1 point for each of fever, purulence, attend within 3 days of onset or less, severely Inflamed tonsils, no cough or coryza) and consider prescribing antibiotics if score is 3 or more – using guidance as follows:

  • Score 0-1: 13-18% likelihood of isolating streptococcus: use NO antibiotics
  • Score 2-3:34-40% likelihood of isolating streptococcus, use back up/delayed antibiotic OR NO antibiotic
  • Score 4 or more:62-65% likelihood of isolating streptococcus, use immediate antibiotic OR back-up antibiotic

Swallowing tablets for children: As we try to ensure children receive the optimum doses of antibiotics, it is of significant benefit if parents or carers can persuade children to swallow tablets. Follow this advice, or send this link direct to parents or carers to help children swallow tablets: or

During our consultation with patients and parents, we try our best to be able to support parents of children with presumed respiratory viral infection and make them aware of features suggestive of Strep A infection, such as clinical deterioration, and when and how to seek further help. You can do so yourself by following safety netting advice found on the link below.

Link to Wessex Healthier Together Safety Netting page:

Learn More about Strep A Infection:

Strep A infection video summary DrRanjOnline