Epididymoorchitis medical therapy: Difference between revisions
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*If the cause is [[enteric]] [[bacteria]]: [[Levofloxacin]] 500 mg orally once daily for 10 days or [[Ofloxacin]] 300 mg orally twice a day for 10 days | *If the cause is [[enteric]] [[bacteria]]: [[Levofloxacin]] 500 mg orally once daily for 10 days or [[Ofloxacin]] 300 mg orally twice a day for 10 days | ||
Patients with epididymoorchitis are managed in an [[outpatient]] basis, unless one of the following [[signs]] or conditions are present: | Patients with epididymoorchitis are managed in an [[outpatient]] basis, unless one of the following [[signs]] or conditions are present:<ref name="pmid19378875">{{cite journal |vauthors=Trojian TH, Lishnak TS, Heiman D |title=Epididymitis and orchitis: an overview |journal=Am Fam Physician |volume=79 |issue=7 |pages=583–7 |year=2009 |pmid=19378875 |doi= |url=}}</ref><ref name="pmid18061028">{{cite journal |vauthors=Tracy CR, Steers WD, Costabile R |title=Diagnosis and management of epididymitis |journal=Urol. Clin. North Am. |volume=35 |issue=1 |pages=101–8; vii |year=2008 |pmid=18061028 |doi=10.1016/j.ucl.2007.09.013 |url=}}</ref> | ||
# Intractable [[pain]], which can also suggest other serious [[Diagnosis|diagnoses]], such as [[testicular]] [[Testicular torsion|torsion]], [[infarction]] or [[necrotizing fasciitis]]. | # Intractable [[pain]], which can also suggest other serious [[Diagnosis|diagnoses]], such as [[testicular]] [[Testicular torsion|torsion]], [[infarction]] or [[necrotizing fasciitis]]. | ||
# Failure of [[outpatient]] care. | # Failure of [[outpatient]] care. | ||
Revision as of 23:02, 27 December 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Medical Therapy
Management of epididymoorchitis consists mainly of conservative measures, including:[1][2][3]
- Bed rest and limitation of physical activity
- Use of cold packs
- Analgesia
- Non-steroidal anti-inflammatory drugs (NSAIDs)
In addition, appropriate antibiotic therapy should be initiated if the cause of epididymoorchitis is bacterial. However, it is not necessary if the underlying etiology is mumps orchitis or other viral epididymoorchitis. The CDC recommends the following anti-bacterial regimens:[3][4]
- If the cause is sexually transmitted (C. trachomatis or N. gonorrhea): Ceftriaxone 250 mg IM in single dose, plus Doxycycline 100 mg orally twice daily for 10 days
- If the cause is enteric bacteria: Levofloxacin 500 mg orally once daily for 10 days or Ofloxacin 300 mg orally twice a day for 10 days
Patients with epididymoorchitis are managed in an outpatient basis, unless one of the following signs or conditions are present:[1][3]
- Intractable pain, which can also suggest other serious diagnoses, such as testicular torsion, infarction or necrotizing fasciitis.
- Failure of outpatient care.
- Patient appears toxic, has severe systemic findings, such as fever and leukocytosis or signs of sepsis.
- Suspicion of an abscess.
- Severe vomiting and inability to tolerate oral medication.
References
- ↑ 1.0 1.1 Trojian TH, Lishnak TS, Heiman D (2009). "Epididymitis and orchitis: an overview". Am Fam Physician. 79 (7): 583–7. PMID 19378875.
- ↑ Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.
- ↑ 3.0 3.1 3.2 Tracy CR, Steers WD, Costabile R (2008). "Diagnosis and management of epididymitis". Urol. Clin. North Am. 35 (1): 101–8, vii. doi:10.1016/j.ucl.2007.09.013. PMID 18061028.
- ↑ Centers for Disease Control and Prevention https://www.cdc.gov/std/treatment/2010/epididymitis.htm. Accessed on Dec. 27, 2016