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Tick-Borne Diseases, Ehrlichiosis: Treatment & Medication

Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Contributor Information and Disclosures

Updated: Sep 17, 2008

Treatment

Emergency Department Care

Do not delay treatment to wait for confirmatory laboratory results. With a strong suspicion of ehrlichiosis, start antibiotic treatment as soon as possible.

Consultations

Consult an infectious disease specialist, particularly if the patient is a child or is pregnant.

Medication

Antibiotic treatment should begin as soon as the diagnosis is ascertained. Antipyretics may be necessary.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.


Doxycycline (Bio-Tab, Doryx, Vibramycin)

Only drug proven to be effective. Inhibits protein synthesis and thus bacterial growth by binding with 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Adult

Hospitalized patients: 100 mg IV bid
Nonhospitalized patients: 100 mg PO bid

Pediatric

Hospitalized patients: 3 mg/kg/d IV bid
Nonhospitalized patients: 3 mg/kg/d PO

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

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

Precautions

Photosensitivity (with prolonged exposure to sunlight or tanning equipment); reduce dose in renal impairment; consider determining drug serum levels in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can permanently discolor teeth; Fanconilike syndrome may occur with outdated tetracyclines

More on Tick-Borne Diseases, Ehrlichiosis

Overview: Tick-Borne Diseases, Ehrlichiosis
Differential Diagnoses & Workup: Tick-Borne Diseases, Ehrlichiosis
Treatment & Medication: Tick-Borne Diseases, Ehrlichiosis
Follow-up: Tick-Borne Diseases, Ehrlichiosis
References
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References

  1. Aguero-Rosenfeld ME, Horowitz HW, Wormser GP, et al. Human granulocytic ehrlichiosis: a case series from a medical center in New York State. Ann Intern Med. Dec 1 1996;125(11):904-8. [Medline].

  2. Bakken JS, Dumler JS, Chen SM, et al. Human granulocytic ehrlichiosis in the upper Midwest United States. A new species emerging?. JAMA. Jul 20 1994;272(3):212-8. [Medline].

  3. Bakken JS, Krueth J, Wilson-Nordskog C, et al. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. JAMA. Jan 17 1996;275(3):199-205. [Medline].

  4. Buller RS, Arens M, Hmiel SP, et al. Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis. N Engl J Med. Jul 15 1999;341(3):148-55. [Medline].

  5. CDC. Human Ehrlichiosis. Available at http://www.cdc.gov/ncidod/dvrd/ehrlichia/Index.htm. Accessed September 4, 2008.

  6. Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. Mar 31 2006;55(RR-4):1-27. [Medline].

  7. Dumler JS, Bakken JS. Ehrlichial diseases of humans: emerging tick-borne infections. Clin Infect Dis. May 1995;20(5):1102-10. [Medline].

  8. Fishbein DB, Dawson JE, Robinson LE. Human ehrlichiosis in the United States, 1985 to 1990. Ann Intern Med. May 1 1994;120(9):736-43. [Medline].

  9. Hamburg BJ, Storch GA, Micek ST, Kollef MH. The importance of early treatment with doxycycline in human ehrlichiosis. Medicine (Baltimore). Mar 2008;87(2):53-60. [Medline].

  10. Heilpern KL. Update: human ehrlichiosis--Maryland and Wisconsin, 1994. Ann Emerg Med. Jul 1998;32(1):108-10. [Medline].

  11. Maeda K, Markowitz N, Hawley RC, et al. Human infection with Ehrlichia canis, a leukocytic rickettsia. N Engl J Med. Apr 2 1987;316(14):853-6. [Medline].

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  13. Ochoa WG, Wedro BC, Firary SA. Images in emergency medicine. Human ehrlichiosis. Ann Emerg Med. Nov 2005;46(5):470, 478. [Medline].

  14. Prince LK, Shah AA, Martinez LJ, Moran KA. Ehrlichiosis: making the diagnosis in the acute setting. South Med J. Aug 2007;100(8):825-8. [Medline].

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  16. Strle F. Human granulocytic ehrlichiosis in Europe. Int J Med Microbiol. Apr 2004;293 Suppl 37:27-35. [Medline].

  17. Walker DH, Dumler JS. Emergence of the ehrlichioses as human health problems. Emerg Infect Dis. Jan-Mar 1996;2(1):18-29. [Medline].

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Further Reading

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Keywords

tick-borne disease, ehrlichiosis, Ehrlichia ewingii, Ehrlichia phagocytophila, human granulocytic ehrlichiosis, HGE, human monocytic ehrlichiosis, HME, vector-borne disease, tick-borne disease, Anaplasma phagocytophilum, human granulocytotropic anaplasmosis, HGA

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Contributor Information and Disclosures

Author

Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Samuel M Keim, MD, Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Charles V Pollack, Jr, MD, MA, FACEP, Professor, Department of Emergency Medicine, University of Pennsylvania College of Medicine; Chairman, Department of Emergency Medicine, Pennsylvania Hospital
Charles V Pollack, Jr, MD, MA, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: sanofi-aventis Honoraria Consulting; sanofi-aventis Honoraria Speaking and teaching; Schering-Polugh Honoraria Consulting; Schering-Plough Honoraria Speaking and teaching; The Medicines Company Honoraria Consulting; GlaxoSmithKline Grant/research funds Other

 
 
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