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Background: Penicillin treatment for 10 days of scarlet fever prevents rheumatic fever and Glomerulonephritis.Correct treatment when the scarlet fever patient present to the clinic is critical public health measure.During epidemic of scarlet fever, we assess the use of diagnosis and treatment of scarlet fever in a major city.Methods: We defined suspected ease as fever plus rash, with sore throat or congestion, A probable case was suspected case with ≧ 1 of strawberry tongue, circumoral pallor or desquamation.Using PPS sampling, we selected scarlet fever patients reported from June 15, 2011-July 15 from four hospitals.We abstracted information from medical records and interview parents of cases patients about symptoms, signs, laboratory tests and medications.Results: of 113 reported cases investigated, 100 met the case definition (Predictive value positive: 88%).Overall 32% of patients had throat culture done.However, only one hospital did throat culture on these cases.All were negative for Group A streptococcus.None received penicillin for 10 days, 32% received penicillin for 6 (Range: 4-7) days, 54% cephalosporin for 7 (Range: 3-10) days.Notably, 39% received dexamethasone.75% Doctors (6/8) knew prefer to using penicillin as the treatment, but did not know for 10 days.Conclusions: Current medical practice were inadequate to prevent rheumatic fever and Glomerulonephritis, this was compound by poor use of diagnostic culture.Other medications could be dangerous, such as dexamethasone, are contraindicated for treatment of Group A streptococcus.