抗生素治疗
治疗建议是根据经验数据。[58]Dumler JS, Madigan JE, Pusterla N, et al. Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment. Clin Infect Dis. 2007 Jul 15;45 Suppl 1:S45-51.http://www.ncbi.nlm.nih.gov/pubmed/17582569?tool=bestpractice.com[53]Bakken JS, Krueth J, Wilson-Nordskog C, et al. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. JAMA. 1989 Nov;160(5):803-9.http://www.ncbi.nlm.nih.gov/pubmed/8604172?tool=bestpractice.com[66]Olano JP, Walker DH. Human ehrlichioses. Med Clin North Am. 2002 Mar;86(2):375-92.http://www.ncbi.nlm.nih.gov/pubmed/11982308?tool=bestpractice.com[109]Thomas RJ, Dumler JS, Carlyon JA. Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Expert Rev Anti Infect Ther. 22009 Aug;7(6):709-22.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739015/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/19681699?tool=bestpractice.com查菲埃立克体和嗜吞噬细胞无形体对常用抗生素耐药，例如青霉素、头孢菌素、大环内酯类、氨基糖苷类、喹诺酮类等药物。[110]Branger S, Rolain JM, Raoult D. Evaluation of antibiotic susceptibilities of Ehrlichia canis, Ehrlichia chaffeensis, and Anaplasma phagocytophilum by real-time PCR. Antimicrob Agents Chemother. 2004 Dec;48(12):4822-8.http://aac.asm.org/cgi/content/full/48/12/4822http://www.ncbi.nlm.nih.gov/pubmed/15561862?tool=bestpractice.com[111]Maurin M, Abergel C, Raoult D. DNA gyrase-mediated natural resistance to fluoroquinolones in Ehrlichia spp. Antimicrob Agents Chemother. 2001 Jul;45(7):2098-105.http://aac.asm.org/cgi/content/full/45/7/2098http://www.ncbi.nlm.nih.gov/pubmed/11408229?tool=bestpractice.com[112]Maurin M, Bakken JS, Dumler JS. Antibiotic susceptibilities of Anaplasma (Ehrlichia) phagocytophilum strains from various geographic areas in the United States. Antimicrob Agents Chemother. 2003 Jan;47(1):413-5.http://aac.asm.org/cgi/content/full/47/1/413http://www.ncbi.nlm.nih.gov/pubmed/12499227?tool=bestpractice.com[113]Rolain JM, Maurin M, Bryskier A, et al. In vitro activities of telithromycin (HMR 3647) against Rickettsia rickettsii, Rickettsia conorii, Rickettsia africae, Rickettsia typhi, Rickettsia prowazekii, Coxiella burnetii, Bartonella henselae, Bartonella quintana, Bartonella bacilliformis, and Ehrlichia chaffeensis. Antimicrob Agents Chemother. 2000 May;44(5):1391-3.http://aac.asm.org/cgi/content/full/44/5/1391http://www.ncbi.nlm.nih.gov/pubmed/10770788?tool=bestpractice.com[114]Brouqui P, Raoult D. In vitro antibiotic susceptibility of the newly recognized agent of ehrlichiosis in humans, Ehrlichia chaffeensis. Antimicrob Agents Chemother. 1992 Dec;36(12):2799-803.http://aac.asm.org/cgi/reprint/36/12/2799http://www.ncbi.nlm.nih.gov/pubmed/1482148?tool=bestpractice.com[115]Klein MB, Nelson CM, Goodman JL. Antibiotic susceptibility of the newly cultivated agent of human granulocytic ehrlichiosis: promising activity of quinolones and rifamycins. Antimicrob Agents Chemother. 1997 Jan;41(1):76-9.http://aac.asm.org/cgi/reprint/41/1/76http://www.ncbi.nlm.nih.gov/pubmed/8980758?tool=bestpractice.com[116]Horowitz HW, Hsieh TC, Aguero-Rosenfeld ME, et al. Antimicrobial susceptibility of Ehrlichia phagocytophila. Antimicrob Agents Chemother. 2001 Mar;45(3):786-8.http://aac.asm.org/cgi/content/full/45/3/786http://www.ncbi.nlm.nih.gov/pubmed/11181361?tool=bestpractice.com[117]Hunfeld KP, Bittner T, Rodel R, et al. New real-time PCR-based method for in vitro susceptibility testing of Anaplasma phagocytophilum against antimicrobial agents. Int J Antimicrob Agents. 2004 Jun;23(6):563-71.http://www.ncbi.nlm.nih.gov/pubmed/15194126?tool=bestpractice.com然而，在大多数病例中，四环素类药物（主要是多西环素）的疗效很好，从未报道过成功治疗后复发。[58]Dumler JS, Madigan JE, Pusterla N, et al. Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment. Clin Infect Dis. 2007 Jul 15;45 Suppl 1:S45-51.http://www.ncbi.nlm.nih.gov/pubmed/17582569?tool=bestpractice.com[66]Olano JP, Walker DH. Human ehrlichioses. Med Clin North Am. 2002 Mar;86(2):375-92.http://www.ncbi.nlm.nih.gov/pubmed/11982308?tool=bestpractice.com[109]Thomas RJ, Dumler JS, Carlyon JA. Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Expert Rev Anti Infect Ther. 22009 Aug;7(6):709-22.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739015/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/19681699?tool=bestpractice.com 在对四环素类药物不耐受或忌用此类药物的患者中，利福平是一种良好的二线药物。[110]Branger S, Rolain JM, Raoult D. Evaluation of antibiotic susceptibilities of Ehrlichia canis, Ehrlichia chaffeensis, and Anaplasma phagocytophilum by real-time PCR. Antimicrob Agents Chemother. 2004 Dec;48(12):4822-8.http://aac.asm.org/cgi/content/full/48/12/4822http://www.ncbi.nlm.nih.gov/pubmed/15561862?tool=bestpractice.com[115]Klein MB, Nelson CM, Goodman JL. Antibiotic susceptibility of the newly cultivated agent of human granulocytic ehrlichiosis: promising activity of quinolones and rifamycins. Antimicrob Agents Chemother. 1997 Jan;41(1):76-9.http://aac.asm.org/cgi/reprint/41/1/76http://www.ncbi.nlm.nih.gov/pubmed/8980758?tool=bestpractice.com[116]Horowitz HW, Hsieh TC, Aguero-Rosenfeld ME, et al. Antimicrobial susceptibility of Ehrlichia phagocytophila. Antimicrob Agents Chemother. 2001 Mar;45(3):786-8.http://aac.asm.org/cgi/content/full/45/3/786http://www.ncbi.nlm.nih.gov/pubmed/11181361?tool=bestpractice.com[118]Dhand A, Nadelman RB, Aguero-Rosenfeld M, et al. Human granulocytic anaplasmosis during pregnancy: case series and literature review. Clin Infect Dis. 2007 Sep 1;45(5):589-93.http://www.ncbi.nlm.nih.gov/pubmed/17682993?tool=bestpractice.com 根据体外药敏试验，不再推荐使用氯霉素。
在绝大多数病例中，治疗开始后 24 至 72 小时退热。 如果在治疗 72 小时后没有发现改善，应当重新评估患者。[109]Thomas RJ, Dumler JS, Carlyon JA. Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Expert Rev Anti Infect Ther. 22009 Aug;7(6):709-22.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739015/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/19681699?tool=bestpractice.com 然而，如果患者的治疗耽搁了几天，可能需要更长时间才有改善。
儿童
在所有儿童中，无论年龄大小，多西环素是推荐的一线治疗，因为用于本适应证的疗程短，认为牙齿和骨骼不良作用可以忽略不计。[58]Dumler JS, Madigan JE, Pusterla N, et al. Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment. Clin Infect Dis. 2007 Jul 15;45 Suppl 1:S45-51.http://www.ncbi.nlm.nih.gov/pubmed/17582569?tool=bestpractice.com[119]Pickering LK, ed. Red book: report of the Committee on Infectious diseases, 28th ed. Elk Grove Village, IL: American Academy of Pediatrics.http://aapredbook.aappublications.org/current.dtl[120]Lantos P, Krause PJ. Ehrlichiosis in children. Semin Pediatr Infect Dis. 2002 Oct;13(4):249-56.http://www.ncbi.nlm.nih.gov/pubmed/12491230?tool=bestpractice.com 对多西环素过敏的儿童中，可以使用利福平作为二线治疗。疗程为发热结束后至少 3 天，通常是 5 至 10 天。[69]Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States. MMWR Recomm Rep. 2016 May 13;65(2):1-44.http://www.cdc.gov/mmwr/volumes/65/rr/rr6502a1.htm?s_cid=rr6502a1_whttp://www.ncbi.nlm.nih.gov/pubmed/27172113?tool=bestpractice.com
