From the Guidelines
The recommended treatment for epididymitis is a combination of antibiotics, with ceftriaxone 1000 mg i.m. or i.v. plus a course of an antibiotic active against Chlamydia trachomatis, as outlined in the European Association of Urology guidelines on urological infections 1. The treatment approach depends on the suspected cause of epididymitis, with consideration of the patient's age and potential exposure to sexually transmitted infections.
- For sexually transmitted epididymitis, the focus is on covering Chlamydia trachomatis and Neisseria gonorrhoeae.
- The use of ceftriaxone, either intramuscularly or intravenously, is recommended due to its efficacy against gonococcal infections, with the addition of an antibiotic effective against Chlamydia trachomatis, such as doxycycline.
- Pain management is crucial and typically involves the use of NSAIDs, such as ibuprofen, along with scrotal support and rest.
- It is essential for patients to abstain from sexual activity until treatment is complete and symptoms have resolved, and for sex partners to be evaluated and treated if necessary, as indicated by guidelines from the Centers for Disease Control and Prevention 1.
- If symptoms do not improve within 3 days of antibiotic therapy, further evaluation is necessary to rule out complications such as an abscess, resistant organism, or incorrect diagnosis.
- The treatment algorithm for epididymitis, as outlined in the European Urology guidelines, emphasizes the importance of clinical assessment, appropriate antibiotic selection, and consideration of parenteral therapy in severe cases 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 recommended treatment for epididymitis caused by N. gonorrhoeae or C. trachomatis is doxycycline (PO) 100 mg, by mouth, twice a day for at least 10 days 2.
- The dosage is the same for both N. gonorrhoeae and C. trachomatis infections.
- The treatment duration is at least 10 days for both types of infections.
From the Research
Treatment for Epididymitis
The recommended 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.
- Supportive measures and antimicrobial agents are the mainstay of therapy for acute epididymitis 4.
- Antibiotic therapy with tetracycline is effective for the treatment of men with Chlamydia trachomatis epididymitis, and should be offered to the female sex partners 5.
- Initial outpatient therapy is empirical and targets the most common pathogens, with ceftriaxone and doxycycline recommended when C. trachomatis and N. gonorrhoeae are suspected, and ofloxacin or levofloxacin recommended when coliform bacteria are suspected 6.
- Erythromycin or tetracycline may be considered for the treatment of acute epididymitis caused by Chlamydia trachomatis 7.