From the Guidelines
The treatment for epididymitis should involve empiric antibiotic therapy, pain management, and supportive measures, with the goal of achieving microbiologic cure, improving signs and symptoms, preventing transmission, and reducing potential complications. For acute bacterial epididymitis, a 10-14 day course of antibiotics is recommended, with specific choices depending on the likely causative organism, as suggested by the Centers for Disease Control and Prevention in their 2002 guidelines 1. The choice of antibiotic should be based on the likely cause of the infection, with doxycycline 100mg twice daily or levofloxacin 500mg once daily often prescribed for sexually transmitted infections, and fluoroquinolones like ciprofloxacin 500mg twice daily effective against enteric organisms. Pain management is also crucial and includes NSAIDs such as ibuprofen 400-600mg three times daily, scrotal elevation, and rest, as well as ice packs to reduce swelling and discomfort, as recommended in the 2002 guidelines 1. Key considerations in the treatment of epididymitis include:
- The need for empiric therapy before culture results are available
- The importance of bed rest, scrotal elevation, and analgesics until fever and local inflammation have subsided, as noted in the 2002 guidelines 1
- The potential for complications such as abscess formation, testicular infarction, or chronic epididymitis if treatment is delayed or inadequate
- The importance of sexual abstinence until symptoms resolve completely to prevent transmission to others. Given the potential for significant morbidity and complications associated with epididymitis, prompt and effective treatment is essential to improve outcomes and quality of life, as emphasized in the 2002 guidelines 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 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.
From the Research
Treatment of Epididymitis
The 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, 4.
- 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.
- For 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.
- Other treatment options include fluoroquinolones or azalides, such as azithromycin, which are effective and easy to use, but require vigilance for the emergence of resistant strains 5.
- The choice of initial antibiotic regimen is empirical and based on the most likely causative pathogen, and adherence to clinical practice guidelines is important to ensure effective treatment 6, 7.
Antibiotic Management
The antibiotic management of epididymitis has advanced in recent years, with a greater understanding of the causative pathogens and the use of modern diagnostic techniques.
- The use of advanced microbiology techniques and studies of current practice provide new insights that have challenged traditional management paradigms 7.
- Identification of specific pathogens and prescribing accuracy is dependent on the extent to which cases are investigated and is therefore variable 7.
- Relatively sparse direct trial data exists on antimicrobial treatments for acute epididymitis, and much of the presently available guidance is derived from previous guidance recommendations and knowledge of antimicrobial activities of specific agents 7.