Answer
Antibiotics
Empiric antimicrobial therapy should cover the most likely pathogens in the context of the clinical setting.
Doxycycline (Vibramycin, Doryx, Adoxa)
This is a second-generation tetracycline. It is more active than tetracycline against many pathogens. Doxycycline has different pharmacokinetics and a different adverse effect profile from tetracycline.
Doxycycline inhibits protein synthesis and thus bacterial growth by binding with 30S and, possibly, 50S ribosomal subunits of susceptible bacteria.
Rifampin (Rifadin)
Rifampin inhibits ribonucleic acid (RNA) synthesis in bacteria by binding to the beta subunit of deoxyribonucleic acid (DNA)-dependent RNA polymerase, which, in turn, blocks RNA transcription.
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Media Gallery
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Female Lone Star tick, Amblyomma americanum, found in the southeastern and Midatlantic United States. It is a vector of several zoonotic diseases, including human monocytic ehrlichiosis and Rocky Mountain spotted fever. Courtesy of the CDC/Michael L. Levin, PhD.
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Map of the United States showing the distribution of the Lone Star Tick, which is the principle vector for ehrlichiosis.
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Established and reported distribution of anaplasmosis vectors Ixodes scapularis and Ixodes pacificus, by county, in the United States from 1907-1996. Courtesy of the Division of Vector-Borne Infectious Diseases at the Centers for Disease Control and Prevention.
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Anaplasmosis incidence by age. Courtesy of the Centers for Disease Control and Prevention.
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Ehrlichiosis incidence by age. Courtesy of the Centers for Disease Control and Prevention.
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This graph displays the number of human cases of ehrlichiosis caused by Ehrlichia chaffeensis reported to the Centers for Disease Control and Prevention (CDC) annually from 2000 through 2016. *From 2000 to 2008, ehrlichiosis was included in the reporting category “human monocytic ehrlichiosis” in reports to the National Notifiable Diseases Surveillance System (NNDSS). **Since 2008, ehrlichiosis has been reported to the NNDSS under the categories “Ehrlichia chaffeensis infections,” “Ehrlichia ewingii infections,” and “Undetermined ehrlichiosis/anaplasmosis infections”, which include infections caused by Ehrlichia muris eauclairensis. Only E chaffeensis infections are shown above. Courtesy of the CDC (https://www.cdc.gov/ehrlichiosis/stats/index.html).
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This graph shows the number of ehrlichiosis cases caused by Ehrlichia chaffeensis reported from 2000 through 2016 by month of onset to illustrate the seasonal trends. Cases are reported in each month of the year, although most are reported in June and July. Courtesy of the CDC (https://www.cdc.gov/ehrlichiosis/stats/index.html).
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This graph shows the number of US ehrlichiosis cases caused by Ehrlichia chaffeensis and reported to the CDC from 2000 to 2018. Courtesy of the CDC (https://www.cdc.gov/ehrlichiosis/stats/).
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