From the Guidelines
Levofloxacin is effective for treating epididymitis, particularly when the cause is likely to be a bacterial infection from common urinary or sexually transmitted pathogens. The typical dosage is 500 mg orally once daily for 10-14 days. Levofloxacin works well against many of the bacteria that commonly cause epididymitis, including Escherichia coli, Chlamydia trachomatis, and Neisseria gonorrhoeae 1. For sexually transmitted epididymitis, it's essential to also treat any sexual partners to prevent reinfection. Patients should complete the full course of antibiotics even if symptoms improve before finishing treatment. While taking levofloxacin, patients should stay well-hydrated and be aware of potential side effects including tendon inflammation, central nervous system effects, and gastrointestinal disturbances.
Some key points to consider when treating epididymitis with levofloxacin include:
- Empiric therapy is indicated before culture results are available, as treatment of epididymitis caused by C. trachomatis or N. gonorrhoeae will result in microbiologic cure of infection, improvement of signs and symptoms, and prevention of transmission to others 1.
- As an adjunct to therapy, bed rest, scrotal elevation, and analgesics are recommended until fever and local inflammation have subsided 1.
- Levofloxacin works by inhibiting bacterial DNA gyrase and topoisomerase IV, which are essential enzymes for bacterial DNA replication and cell division, thereby killing the bacteria causing the infection.
It's crucial to note that the most recent and highest quality study 1 supports the use of levofloxacin for treating epididymitis, and its recommendations should be prioritized in clinical practice.
From the Research
Effectiveness of Levofloxacin for Epididymitis
- Levofloxacin is a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including those that cause epididymitis 2.
- 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, 4.
- The treatment of epididymitis depends on the patient's age and the likely causative organisms, with levofloxacin being a recommended treatment option for men older than 35 years with enteric bacteria infections 3, 4.
- Levofloxacin has been shown to be effective in the treatment of genitourinary tract infections, including those caused by enteric bacteria 2.
Considerations for Treatment
- The etiology of epididymitis is largely unknown, but reflux of urine into the ejaculatory ducts is considered a common cause in children and men with bladder outlet obstruction 3, 4.
- Neisseria gonorrhoeae and Chlamydia trachomatis are the most common pathogens in sexually active males 14 to 35 years of age, and a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline is the treatment of choice in this age group 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.
- Rising resistance to ciprofloxacin in E. coli isolates in Europe and the USA means that alternative antimicrobials, such as levofloxacin, may be necessary for the treatment of epididymo-orchitis in men over 35 years old 5.