From the Guidelines
For acute epididymitis in adults, antibiotic treatment should be started empirically based on the likely cause, with the most recent guidelines suggesting treatment for Chlamydia trachomatis and Neisseria gonorrhoeae in sexually active men under 35, and coverage for common urinary tract pathogens in men over 35 or those not sexually active 1.
Key Considerations
- The recommended regimen for sexually active men under 35 typically includes ceftriaxone and doxycycline, as these antibiotics target the most common causes of epididymitis in this population 1.
- For men over 35 or those not sexually active, levofloxacin is often recommended as it provides broad coverage against common urinary tract pathogens 1.
- It is essential to initiate treatment as soon as possible after diagnosis, and patients should be instructed to abstain from sexual intercourse until completion of therapy 1.
- Supportive measures such as rest, scrotal elevation, and anti-inflammatory medications are also crucial in managing symptoms and promoting recovery 1.
Treatment Regimens
- For sexually active men under 35: ceftriaxone 500 mg intramuscularly as a single dose, plus doxycycline 100 mg orally twice daily for 10 days.
- For men over 35 or those not sexually active: levofloxacin 500 mg orally once daily for 10 days.
- Alternative regimens may be considered based on patient-specific factors, such as allergy or resistance patterns 1.
Monitoring and Follow-Up
- Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy 1.
- Partner referral and treatment are also essential in preventing the spread of infection and promoting public health 1.
From the FDA Drug Label
Acute epididymo-orchitis caused by N. gonorrhoeae: 100 mg, by mouth, twice a day for at least 10 days. Acute epididymo-orchitis caused by C. trachomatis: 100 mg, by mouth, twice a day for at least 10 days The antibiotic treatment for epididymitis (inflammation of the epididymis) is doxycycline 100 mg, by mouth, twice a day for at least 10 days for cases caused by N. gonorrhoeae or C. trachomatis 2.
- The dosage is the same for both N. gonorrhoeae and C. trachomatis infections.
- The treatment duration is at least 10 days.
From the Research
Antibiotic Treatment for Epididymitis
The antibiotic treatment for epididymitis varies based on the patient's age and the likely causative organisms.
- For sexually active males between 14 and 35 years of age, the most common pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis, and the treatment of choice is a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline 3.
- In men who practice insertive anal intercourse, an enteric organism is also likely, and ceftriaxone with 10 days of oral levofloxacin or ofloxacin is the recommended treatment regimen 3.
- In men older than 35 years, epididymitis is usually caused by enteric bacteria, and levofloxacin or ofloxacin alone is sufficient to treat these infections 3.
- Quinolones, such as ciprofloxacin, are also commonly prescribed as first-line antibiotics for the treatment of epididymitis 4.
- For patients with indwelling urethral catheters, empirical treatment with both a fluoroquinolone and a third-generation cephalosporin is recommended until antimicrobial susceptibility testing has been completed 5.
- The treatment of N. gonorrhoeae requires a single-dose regimen active against this organism, plus a 7- to 10-day tetracycline regime active against C. trachomatis and nongonococcal urethritis 6.
Adherence to Guidelines
- Adherence to Centers for Disease Control (CDC) guidelines for the treatment of acute epididymitis is not always followed, with less than 35% of adult men undergoing the appropriate CDC work-up 7.
- Despite a paucity of documented urinary infection, 97% of adult men are treated empirically with antibiotics, often not in accordance with CDC guidelines 7.