埃里希体病和边虫病

多西环素是推荐的一线治疗。[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 在大多数病例中，多西环素的疗效很好，从未报告过成功治疗后复发。[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[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[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

尽管多西环素通常不用于孕妇，但可以用于被认为病情严重或危及生命的病例。

四环素的耐受性不如多西环素，需要更加频繁地给药。由于四环素对胎儿骨质和牙齿发育有不良作用，不推荐用于孕妇。[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[121]Purvis JJ, Edwards MS. Doxycycline use for rickettsial disease in pediatric patients. Pediatr Infect Dis J. 2000 Sep;19(9):871-4.http://www.ncbi.nlm.nih.gov/pubmed/11001111?tool=bestpractice.com

患者应当接受口服给药，除非因为重度疾病或其他原因不能耐受口服药物，在这种情况下，静脉给药。

疗程为发热结束后至少 3 天，通常是 5 至 10 天。

针对经选择患者组全部患者的治疗推荐

在对四环素类药物过敏或有禁忌证的患者中，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[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使用利福平治疗孕妇也取得了一些成功。

患者应当接受口服给药，除非因为重度疾病或其他原因不能耐受口服药物；在这种情况下，要静脉给药。

疗程为发热结束后至少 3 天，通常是 5 至 10 天。

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[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

在大多数病例中，多西环素的疗效很好，从未报告过成功治疗后复发。[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[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[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

患者应当接受口服给药，除非因为重度疾病或其他原因不能耐受口服药物，在这种情况下，静脉给药。

疗程为发热结束后至少 3 天，通常是 5 至 10 天。

针对经选择患者组全部患者的治疗推荐

在对多西环素药物过敏或有禁忌证的儿童中，可以使用利福平作为二线治疗。[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

患者应当接受口服给药，除非因为重度疾病或其他原因不能耐受口服药物；在这种情况下，要静脉给药。

疗程为发热结束后至少 3 天，通常是 5 至 10 天。