What is the antibiotic (abx) of choice for a 14-year-old male with epididymitis?

Antibiotic Treatment for Epididymitis in a 14-Year-Old Male

For a 14-year-old male with epididymitis, the recommended antibiotic regimen is ceftriaxone 250 mg IM as a single dose PLUS doxycycline 100 mg orally twice daily for 10 days. 1

Etiology and Rationale

In adolescent males under 35 years of age, epididymitis is most commonly caused by sexually transmitted infections:

• Chlamydia trachomatis
• Neisseria gonorrhoeae

The dual antibiotic approach targets both pathogens:

• Ceftriaxone: Effective against N. gonorrhoeae
• Doxycycline: Effective against C. trachomatis

Treatment Algorithm

1. Initial Assessment:

   • Rule out testicular torsion (surgical emergency)
   • Look for unilateral testicular pain, tenderness, swelling of epididymis
   • Check for urethral discharge or urinary symptoms

2. Diagnostic Workup (should be performed but not delay treatment):

   • Urethral swab or first-void urine for N. gonorrhoeae and C. trachomatis
   • Gram stain of urethral discharge if present
   • Urine culture

3. Antibiotic Treatment:

   • Ceftriaxone 250 mg IM single dose 1
   • PLUS
   • Doxycycline 100 mg orally twice daily for 10 days 2

4. Adjunctive Measures:

   • Bed rest
   • Scrotal elevation
   • Analgesics until fever and inflammation subside 1

Follow-Up Considerations

• Improvement should be seen within 3 days of starting treatment
• If no improvement within 3 days, reevaluation of diagnosis and therapy is required 1
• Sexual partners should be evaluated and treated if contact occurred within 60 days of symptom onset 1

Important Caveats

• Testicular torsion must be ruled out, especially in adolescents where it's more common 1
• Avoid fluoroquinolones (like ofloxacin) as first-line therapy in this age group, as they're more appropriate for men >35 years with enteric organisms 3
• Sexual history should be obtained sensitively and confidentially
• Patient should abstain from sexual activity until treatment is complete and symptoms have resolved 1

Alternative Regimen

If there is a documented severe allergy to cephalosporins or tetracyclines, consult with an infectious disease specialist, as the standard alternative regimens may not be appropriate for a 14-year-old.

The evidence strongly supports this dual antibiotic approach for adolescent males with epididymitis to effectively treat the most likely causative organisms, prevent complications such as infertility, and reduce disease transmission 1, 3.