From the Guidelines
Levofloxacin (Levaquin) is not the first-line treatment for epididymitis, but it can be used as an alternative regimen, typically prescribed at 500 mg once daily for 10-14 days. The most recent and highest quality study 1 recommends levofloxacin as an alternative regimen for the treatment of nongonococcal urethritis, which can be a cause of epididymitis. For acute epididymitis likely caused by sexually transmitted infections (common in men under 35), the recommended treatment is a combination of antibiotics, such as ceftriaxone and doxycycline 1.
Important Considerations
- Patients should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen, provided their symptoms have resolved 1.
- To minimize the risk for reinfection, men should be instructed to abstain from sexual intercourse until all of their sex partners are treated 1.
- Persons who have been diagnosed with a new STD should receive testing for other infections, including syphilis and HIV 1.
Treatment Regimen
- The recommended regimen for epididymitis is typically a combination of antibiotics, such as ceftriaxone and doxycycline 1.
- Levofloxacin can be used as an alternative regimen, typically prescribed at 500 mg once daily for 10-14 days 1.
Supportive Measures
- Pain relief with NSAIDs, scrotal elevation, and rest are important supportive measures during treatment.
- Patients should stay well-hydrated and complete the full course of antibiotics even if symptoms improve.
- Patients should be aware of potential side effects including tendon inflammation, QT prolongation, and photosensitivity, and should seek immediate medical attention if experiencing severe side effects.
From the Research
Levoquin for Epididymitis
- Levoquin, also known as levofloxacin, is a fluoroquinolone antibiotic that is used to treat various bacterial infections, including epididymitis 2, 3.
- According to the study published in the American Family Physician in 2016, levofloxacin is recommended as a treatment option for epididymitis in men older than 35 years, as well as in men who practice insertive anal intercourse 2.
- The study published in the American Family Physician in 2009 also recommends levofloxacin as a treatment option for epididymitis when coliform bacteria are suspected 3.
- Another study published in Expert Opinion on Pharmacotherapy in 2022 discusses the advances in antibiotic management of epididymitis, but does not specifically mention levoquin as a treatment option 4.
- A study published in European Urology in 2004 found that quinolones, including ciprofloxacin, were the most commonly prescribed first-line antibiotic for acute epididymitis, but notes that ciprofloxacin is not the optimal antimicrobial for the treatment of urogenital chlamydial infection 5.
- A systematic review published in Sexually Transmitted Diseases in 2018 highlights the need for more prospective studies evaluating treatment regimens for acute epididymitis, including the use of levoquin 6.
Treatment Guidelines
- The treatment guidelines for epididymitis recommend the use of antibiotics, including levofloxacin, based on the suspected causative pathogen and the patient's age and medical history 2, 3.
- The choice of antibiotic regimen is empirical and based on the most likely causative pathogen, whether sexually transmitted, enteric, or other 4.