From the Guidelines
For bacterial epididymo-orchitis, a 10-14 day course of antibiotics is typically recommended. The European Association of Urology guidelines on urological infections, as outlined in the 2024 guidelines 1, suggest that the treatment should target the most common causative organisms, including Chlamydia trachomatis and Enterobacterales.
- The first-line treatment usually consists of a single antibiotic or a combination of two antibiotics active against these organisms.
- Ceftriaxone 1000 mg i.m. or i.v. plus a course of an antibiotic active against Chlamydia trachomatis is recommended, especially if gonorrhoea is likely.
- The choice of antibiotic and duration of treatment should be based on the clinical assessment and diagnosis, as well as the presence of any complications such as abscess formation.
- Supportive measures, including bed rest, scrotal elevation, and analgesics, should also be considered to prevent complications and improve patient outcomes.
- It is essential to note that the treatment should begin promptly to prevent long-term sequelae such as infertility or testicular damage, and that the antibiotic course should be completed as directed to ensure effective treatment and prevent antibiotic resistance 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 antibiotic course for bacterial epididymo-orchitis is at least 10 days of doxycycline, with a dose of 100 mg, twice a day 2.
- The treatment duration is the same for both N. gonorrhoeae and C. trachomatis infections.
- The dosage is 100 mg, twice a day, which should be taken for at least 10 days.
From the Research
Antibiotic Course Duration for Bacterial Epididymo-Orchitis
The duration of an antibiotic course for bacterial epididymo-orchitis is dependent on the causative organism and the patient's age.
- For sexually active males aged 14 to 35 years, the recommended treatment is a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline 3.
- For 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.
Considerations for Antibiotic Selection
The selection of antibiotics should be based on the likely causative organism and the patient's age.
- For sexually active men under 35 years, Neisseria gonorrhoeae and Chlamydia trachomatis are the most common pathogens, and a regimen that covers these organisms is recommended 4, 3.
- For men over 35 years, enteric bacteria are more common, and a fluoroquinolone antibiotic such as levofloxacin or ofloxacin is recommended 3, 5.
Importance of Early Treatment
Early diagnosis and treatment of epididymo-orchitis are essential to reduce the risk of complications such as abscess formation, testicular infarction, and infertility 5.