This page was last updated Dec 30, 2022

This page covers:

  • Group A Strep
  • Scarlet fever
  • Sore throat and tonsillitis
  • Invasive Group A Strep (iGAS)
  • Poorly child?
  • Information videos
  • Antibiotic use
  • Antibiotic shortage
  • Preventing infection


We are being inundated with many calls from concerned parents regarding group A strep. The following resources may be useful, not just for parents, but for other patients too:

Facts about the current Group A Strep situation

  • Strep A is a common infection seen every year
  • Some of us even carry it up our noses, in our throats or on our skin without harm or illness
  • It can cause scarlet fever and tonsillitis
  • Most cases are mild and easily treated with antibiotics
  • The most serious form (called invasive Group A Strep or iGAS), which is luckily extremely rare, is what has caused the deaths as reported in the media
  • As with all winters, other bugs are circulating, causing sore throats, coughs, colds and sneezing
  • Many of these are caused by viruses, so cannot be treated with antibiotics

Scarlet fever

Scarlet fever is caused by streptococcal infection and is treated with antibiotics.

Typical symptoms include: temperature, sore throat, swollen neck glands, headache, nausea, vomiting, tired, malaise, flushing. After 12-48 hours, a sandpapery rash starts on the trunk, then spreading, there may be a tongue that looks like a strawberry (red with white spots or white with red spots).

NHS: Scarlet Fever

If you think your child has scarlet fever, please get in touch and please be prepared to submit photos.

Sore throat and tonsillitis

Most cases of sore throat and tonsillitis are actually caused by viruses and will settle on their own, without the need for antibiotics.

Just because you have a sore throat, does not automatically mean that you must have strep A tonsillitis.

Typical symptoms include: temperature, sore throat, difficulty swallowing, swollen neck glands, bad breath, pus (slime) or white spots on the tonsils, headache, earache, tired, malaise.

NHS: Sore throat

Minor illness leaflet on sore throat

NHS: Tonsillitis

If your child has pus on the tonsils, cannot eat or drink or has persistent symptoms that are not resolving, please get in touch and please be prepared to submit photos.

Invasive Group A Strep (iGAS)

This is fortunately extremely rare [in fact, flu causes more deaths in children every year than the current strep A situation but never makes the news]. Invasive Group A Strep is where the bacteria breaches into the circulation. Those affected could be completely well with little in the way of symptoms and then severely ill within only a matter of a few hours. Worryingly, this sudden deterioration can occur even after a recent assessment by a doctor or if already started on antibiotics.

Therefore the key here is vigilance to a change in condition and seeking advice if your child deteriorates. If you think your child is seriously ill, do not delay, take your child to the local A&E department or ring 999.

The difficulty with children can be in telling if they are seriously ill. Therefore the next section of resources might be useful.

How can I tell if my child is poorly?

Please see our poorly child leaflet which gives color-coded symptoms to look out for and what to do:

How can I tell if my child is poorly?

Parents are advised to familiarise themselves with the contents of the chart but particularly with the symptoms in the red (A&E) and blue (999) columns of the chart that could indicate more serious illness.

Also please see these resources:

How can I tell if I am poorly?

Please visit our specific page which details symptoms to look out for that could indicate serious ill-health:

How to tell if I am poorly page

Medical emergencies

Serious ill-health

Information videos from doctors

Dr Sophie, GP: Strep A and Scarlet Fever

Dr Rowland, Paediatric Emergency Consultant: Parent and Carer advice on Group A Strep and Scarlet Fever

Dr O'Donovan: Scarlet Fever (Group A Strep) - causes, symptoms and treatment

Not everything can be treated with antibiotics

As indicated, most of the circulating bugs in winter and spring are actually viruses, for which antibiotics will not work. Therefore please do not be offended if, after assessing your case, the doctor does not feel antibiotics are indicated.

There are drawbacks to overuse/indiscriminate use of antibiotics - some of the harm caused is not easily quantifiable, but can include:

  • Increased resistance of bacteria, meaning antibiotics may not work for more serious infections, like meningitis or pneumonia
  • Supply problems meaning much needed antibiotics might not be available to other patients with other conditions
  • Increased risk of side effects like rash, which may result in a patient being inappropriately labelled as being allergic to penicillin, thereby removing an extremely useful tool in the fight against infection for that patient for the rest of their life
  • Increased demand on health services due to calls for antibiotics means that patients with other conditions, some of which may be serious, may not be able to get through to access the care that they need

Shortage of phenoxymethylpenicillin

There is currently a severe shortage of phenoxymethylpenicillin, the antibiotic used to treat strep A infection. If you have been given a prescription for this medication and the pharmacist indicates that this is not available, then please ask them to follow the current 'serious shortage protocol' for that medication (links below).

This protocol enables pharmacists to issue an alternative antibiotic to you, without the need for a new prescription or any intervention or authorisation from the GP.

Preventing spread of infection

Even though we have just had a global pandemic, many people are forgetting the cardinal rules of preventing spread of infection:

  • If you're ill don't go to school or work
  • Use a tissue to catch coughs and sneezes
  • Regular hand washing
  • Regularly clean surfaces with disinfectant
  • Clean and cover wounds

Other official information

GOV: Strep A and scarlet fever

GOV: 5 ways to protect your under 5s this winter

GOV: Interim clinical guidance summary

NHS: Serious Shortage Protocols (SSPs)