eMedicine Specialties > Infectious Diseases > Bacterial Infections

Ehrlichiosis: Treatment & Medication

Author: Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Feb 5, 2009

Treatment

Medical Care

  • Patients who are moderately-to-severely ill may be hospitalized for diagnosis and therapy.

Consultations

  • An infectious disease specialist should be consulted for any patient with an acute febrile illness and a recent history of tick exposure.
  • A hematologist should be consulted if hemorrhagic manifestations are present.

Diet

  • Diet is as usual.

Activity

  • Activity may be altered depending on the severity of illness.

Medication

The preferred drug for both human monocytic ehrlichiosis (HME) and human granulocytic anaplasmosis (HGA) is doxycycline. In contrast to RMSF, chloramphenicol is not effective in ehrlichiosis. Although experience is limited, in vivo data suggest that rifampin may be useful in patients who are unable to take doxycycline (eg, children <8 y, pregnant females). Fluoroquinolones may be useful against Ehrlichia, but experience is limited.

Antibiotics

Empiric antimicrobial therapy should cover the most likely pathogens in the context of the clinical setting.


Doxycycline (Vibramycin)

Second-generation tetracycline. More active than tetracycline against many pathogens. Different adverse effect profile and pharmacokinetics compared to tetracycline. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Adult

100-200 mg IV/PO q12h

Pediatric

<8 years: Not recommended
>8 years: Administer as in adults

Bioavailability minimally decreased with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur rarely; tetracycline use during tooth development (last one-half of pregnancy through age 8 y) can cause permanent discoloration of teeth

More on Ehrlichiosis

Overview: Ehrlichiosis
Differential Diagnoses & Workup: Ehrlichiosis
Treatment & Medication: Ehrlichiosis
Follow-up: Ehrlichiosis
Multimedia: Ehrlichiosis
References
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Further Reading

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Keywords

ehrlichiosis, human monocytic ehrlichiosis, HME, human granulocytic anaplasmosis, HGA, human granulocytic ehrlichiosis, HGE, spotless Rocky Mountain spotted fever, Ehrlichia, Ehrlichia chaffeensis, E chaffeensis, Erlichia ewingii, E ewingii, Anaplasma phagocytophilum, A phagocytophilum, morulae

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Contributor Information and Disclosures

Author

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Thomas J Marrie, MD, Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine
Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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