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
- Antibiotics are recommended in the treatment of epididymo-orchitis, specifically for cases caused by N. gonorrhoeae or C. trachomatis, with a dosage of 100 mg of doxycycline, by mouth, twice a day for at least 10 days 1
From the Research
Antibiotics are recommended in the treatment of epididymo-orchitis, particularly when the cause is bacterial. For suspected bacterial epididymo-orchitis, empiric antibiotic therapy should be started promptly. The recommended regimen typically includes ceftriaxone 1g intramuscularly and doxycycline, as suggested by the most recent guideline 2.
Key Considerations
- For enteric organisms (often in men over 35 or following urinary tract instrumentation), ofloxacin or levofloxacin is recommended 2.
- Pain management with NSAIDs, scrotal elevation, and rest are important supportive measures.
- Antibiotics are crucial because untreated bacterial epididymo-orchitis can lead to abscess formation, testicular infarction, or chronic pain.
- If the condition is determined to be viral or non-infectious in origin, antibiotics would not be beneficial.
Patient Evaluation and Treatment
- Patients should complete the full course of antibiotics even if symptoms improve quickly, and should be reevaluated if symptoms persist beyond 3 days of treatment.
- A clinical care pathway has been produced to simplify the management of epididymo-orchitis 2.
- The treatment of epididymo-orchitis depends on the likely causative organisms, which vary based on patient age and other factors 3.
Important Treatment Details
- Ceftriaxone and doxycycline are recommended in those at high risk of gonorrhoea 2, 4.
- Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms 2.
- Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin) 2.