Clinical Care of Ehrlichiosis

Key points

  • Doxycycline is the treatment of choice for patients of all ages with ehrlichiosis and all other tickborne rickettsial diseases.
  • When treated with doxycycline, fever usually resolves within 24–48 hours.
A keyboard and a stethoscope.

Who should receive treatment

  • Doxycycline is the first-line treatment for adults and children of all ages.

Treatment recommendations

  • Doxycycline is most effective at preventing severe complications if it is started within the first week of illness.

Doxycycline is the first-line treatment for adults and children of all ages:

  • Adults: 100 mg twice daily
  • Children under 45 kg (100 lbs.): 2.2 mg/kg body weight given twice a day (maximum dose 100mg twice daily)

Patients with suspected ehrlichiosis should be treated with doxycycline for at least 5-7 days, and until 72 hours after the subsidence of fever with evidence of clinical improvement.

  • Antibiotic prophylaxis after a tick bite is not recommended to prevent ehrlichiosis.
  • People who have been bitten by a tick should watch for signs and symptoms. They should see their healthcare provider if fever, rash, headache or other symptoms develop within 2 weeks of tick bite.

Treatment timeline

  • When treated with doxycycline, fever generally subsides within 24–48 hours.
  • Lack of a clinical response to doxycycline suggests that the patient's condition might not be due to ehrlichiosis.
  • Resistance to doxycycline or relapses in symptoms after the completion of the recommended course have not been documented.
Two photomicrographs showing types of ehrlichiosis.
A photomicrograph shows ehrlichiosis.