Epididymoorchitis medical therapy: Difference between revisions

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Revision as of 03:02, 1 September 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Management of epididymoorchitis consists mainly of conservative measures, including bed rest and limitation of physical activity, use of cold packs, analgesia and non-steroidal anti-inflammatory drugs (NSAIDs). In addition, appropriate antibiotic therapy should be initiated if the cause of epididymoorchitis is bacterial.^[1]^[2]^[3]

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)

If acute epididymitis is most likely caused by chlamydia or gonorrhea

Preferred regimen: Ceftriaxone 500mg IM single dose PLUS doxycycline 100mg PO bid for 10 days.^[4]

If acute epididymitis most likely caused by chlamydia, gonorrhea, or enteric organisms (men who practice insertive anal sex)

Preferred regimen: Ceftriaxone 500mg IM single dose PLUS levofloxacin 500mg PO qd for 10 days.^[4]

If acute epididymitis most likely caused by enteric organisms only

Preferred regimen: Levofloxacin 500mg PO qd for 10 days.^[4]
- If patient weights more than 150kg - give ceftriaxone 1gr IM single dose.

Antibiotics are not necessary if the underlying etiology is likely viral such as mumps orchitis or other viral epididymoorchitis.

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.
↑ ^2.0 ^2.1 Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.
↑ ^3.0 ^3.1 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.
↑ ^4.0 ^4.1 ^4.2 Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check |pmc= value (help). PMID 34292926 Check |pmid= value (help).

Template:WH Template:WS

[pmid19378875-1] 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.

[pmid21490048-2] 2.0 ^2.1 Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.

[pmid18061028-3] 3.0 ^3.1 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.

[pmid34292926-4] 4.0 ^4.1 ^4.2 Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check |pmc= value (help). PMID 34292926 Check |pmid= value (help).

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@@ Line 14: / Line 14: @@
 *[[Non-steroidal anti-inflammatory drugs]] ([[NSAIDs]])<br>
-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 [[Antibacterial|anti-bacterial]] regimens:<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><ref name= "CDC"> Centers for Disease Control and Prevention https://www.cdc.gov/std/treatment/2010/epididymitis.htm. Accessed on Dec. 27, 2016 </ref>
+===If acute [[epididymitis]] is most likely caused by [[chlamydia]] or [[gonorrhea]]===
-*If the cause is [[sexually transmitted]] (''[[Chlamydia trachomatis|C. trachomatis]]'' or ''[[Neisseria gonorrhoeae|N. gonorrhea]]''): [[Ceftriaxone]] 250 mg [[Intramuscularly|IM]] in single dose, plus [[Doxycycline]] 100 mg orally twice daily for 10 days
+* Preferred regimen: [[Ceftriaxone]] 500mg IM single dose '''PLUS''' [[doxycycline]] 100mg PO bid for 10 days.<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref>
-*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 acute [[epididymitis]] most likely caused by [[chlamydia]], [[gonorrhea]], or [[enteric organisms]] (men who practice insertive anal sex)===
+* Preferred regimen: [[Ceftriaxone]] 500mg IM single dose '''PLUS''' [[levofloxacin]] 500mg PO qd for 10 days.<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref>
+===If acute [[epididymitis]] most likely caused by [[enteric organisms]] only===
+* Preferred regimen: [[Levofloxacin]] 500mg PO qd for 10 days.<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref>
+** If patient weights more than 150kg - give [[ceftriaxone]] 1gr IM single dose.
+Antibiotics are not necessary if the underlying etiology is likely viral such as [[mumps]] orchitis or other [[viral]] [[epididymoorchitis]].
 ==References==