From the Research
For epididymitis, ciprofloxacin is typically prescribed at a dose of 500 mg orally twice daily for 10-14 days. This antibiotic regimen is particularly effective for cases caused by enteric gram-negative bacteria or when sexually transmitted infections like chlamydia and gonorrhea have been ruled out 1, 2. The most recent and highest quality study supporting this dose is from 1999, which compared the efficacy of ciprofloxacin with pivampicillin as oral therapy for epididymitis in men over 40 years of age, and found that ciprofloxacin 500 mg orally twice daily was more effective than pivampicillin 700 mg orally twice daily and had fewer adverse events 1.
Key Considerations
- Patients should take the full course of antibiotics even if symptoms improve before completion.
- It's essential to stay well-hydrated while taking ciprofloxacin and to avoid antacids, dairy products, or multivitamins within 2 hours of taking the medication as these can reduce absorption.
- Ciprofloxacin works by inhibiting bacterial DNA gyrase, preventing bacterial DNA replication.
- Common side effects include nausea, diarrhea, and headache.
- Patients should seek immediate medical attention if they experience tendon pain, as ciprofloxacin carries a risk of tendon rupture, particularly in older adults.
Special Cases
- For sexually transmitted epididymitis, doxycycline (100 mg twice daily for 10 days) is often preferred or added to the regimen 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.
- In men older than 35 years, epididymitis is usually caused by enteric bacteria transported by reflux of urine into the ejaculatory ducts secondary to bladder outlet obstruction; levofloxacin or ofloxacin alone is sufficient to treat these infections 3.