From the FDA Drug Label
The following in vitro data are available, but their clinical significance is unknown: Levofloxacin exhibits in vitro minimum inhibitory concentrations (MIC values) of 2 mcg/mL or less against most (≥ 90%) isolates of the following microorganisms; however, the safety and effectiveness of levofloxacin in treating clinical infections due to these bacteria have not been established in adequate and well-controlled clinical trials
Gram-Positive Bacteria
- Enterococcus faecalis
- Staphylococcus aureus (methicillin-susceptible isolates)
- Staphylococcus epidermidis (methicillin-susceptible isolates)
- Staphylococcus saprophyticus
- Streptococcus pneumoniae (including multi-drug resistant isolates [MDRSP])
- Streptococcus pyogenes
Gram-Negative Bacteria
- Enterobacter cloacae
- Escherichia coli
- Haemophilus influenzae
- Haemophilus parainfluenzae
- Klebsiella pneumoniae
- Legionella pneumophila
- Moraxella catarrhalis
- Proteus mirabilis
- Pseudomonas aeruginosa
- Serratia marcescens
The antibiotics that can be used to treat an infected hydrocele are levofloxacin and piperacillin-tazobactam, as they have shown in vitro activity against a range of Gram-positive and Gram-negative bacteria, including those that may cause infections in the genital area 1 2. However, the specific choice of antibiotic will depend on the severity of the infection, the causative organism, and the patient's individual circumstances.
From the Research
Antibiotics commonly used to treat an infected hydrocele include broad-spectrum options such as cephalosporins (ceftriaxone 1-2g IV daily), fluoroquinolones (ciprofloxacin 500mg orally twice daily), or a combination of amoxicillin-clavulanate (875/125mg orally twice daily) for 7-14 days depending on severity. Treatment typically begins with intravenous antibiotics if the infection is severe, followed by oral antibiotics once improvement is noted. The choice of antibiotic should target common urogenital pathogens including gram-negative bacteria like E. coli and gram-positive organisms such as Staphylococcus species 3. In addition to antibiotics, treatment often requires drainage of the infected fluid through aspiration or surgical intervention. Pain management with analgesics and scrotal support are important adjunctive measures. Patients should be monitored closely for improvement, with consideration for changing antibiotics if there's no response within 48-72 hours. The underlying cause of the hydrocele should also be addressed to prevent recurrence, as infected hydroceles often result from underlying epididymitis, orchitis, or trauma.
Some key points to consider when selecting an antibiotic regimen include:
- The severity of the infection and the patient's overall health status
- The likelihood of antibiotic resistance in the community
- The potential side effects and interactions of the selected antibiotic
- The need for drainage of the infected fluid and surgical intervention
It's also important to note that aspiration and sclerotherapy with doxycycline is a nonsurgical treatment option for hydroceles, with a success rate of 84% in one study 4. However, this treatment may not be suitable for all patients, and the decision to use it should be made on a case-by-case basis.
In terms of specific antibiotic regimens, a study from 2020 found that nitrofurantoin, fosfomycin, and pivmecillinam are effective options for treating urinary tract infections, including those caused by antibiotic-resistant bacteria 3. Another study from 2013 found that ciprofloxacin is effective in treating urinary tract infections, with a success rate of 94.5% in one study 5. However, the choice of antibiotic should always be guided by the specific needs of the patient and the results of any available culture and sensitivity testing.
Overall, the treatment of an infected hydrocele requires a comprehensive approach that includes antibiotics, drainage of the infected fluid, and addressing the underlying cause of the infection. The goal of treatment is to eradicate the infection, prevent recurrence, and improve the patient's quality of life.