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Epididymitis Medication

  • Author: Christina B Ching, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Dec 20, 2015
 

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

 

This is a third-generation cephalosporin with broad-spectrum gram-negative activity. Ceftriaxone has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Doxycycline (Doryx, Vibramycin)

 

Doxycycline is used to treat C trachomatis infection. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Azithromycin (Zithromax)

 

Azithromycin acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.

Azithromycin concentrates in phagocytes and fibroblasts, as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. Azithromycin is used for the treatment of gonococcal infections, chlamydia, or both.

Ofloxacin (Floxin)

 

Ofloxacin penetrates the prostate well and is effective against C trachomatis. It is no longer recommended to use fluoroquinolones to treat gonococcal infections secondary to a high rate of resistance. Ofloxacin is a pyridine carboxylic acid derivative with broad-spectrum bactericidal effect.

Ciprofloxacin (Cipro)

 

This agent is for bacterial infections. Ciprofloxacin is no longer recommended for gonococcal and nongonococcal infections, such as chlamydia, given their incomplete coverage and increased rate of resistance.

Trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)

 

This is for the empiric treatment of nonspecific bacterial infection.

Levofloxacin (Levaquin)

 

Levofloxacin is excreted in the urine and is effective against C trachomatis. It is no longer recommended to use fluoroquinolones to treat gonococcal infections secondary to a high rate of resistance. Levofloxacin is a pyridine carboxylic acid derivative with broad-spectrum bactericidal effect.

Ampicillin

 

Ampicillin is used for the treatment of systemic illness warranting hospitalization. It is a broad-spectrum penicillin, and it interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Ampicillin is an alternative to amoxicillin when the patient is unable to take medication orally.

Until recently, the HACEK bacteria were uniformly susceptible to ampicillin. Recently, however, beta-lactamase–producing strains of HACEK have been identified.

Gentamicin

 

Gentamicin is used for the treatment of systemic illness warranting hospitalization. It is an aminoglycoside antibiotic for coverage of gram-negative bacteria, including pseudomonal species. It is synergistic with beta-lactamase against enterococci. It interferes with bacterial protein synthesis by binding to the 30S and 50S ribosomal subunits.

Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in the volume of distribution, as well as the body space into which the agent needs to distribute. Gentamicin may be given IV/IM. Each regimen must be followed by at least a trough level drawn on the third or fourth dose, 0.5 hour before dosing; a peak level may be drawn 0.5 hour after a 30-minute infusion.

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Antituberculous drugs

Class Summary

These agents are used to treat tuberculous epididymo-orchitis.

Rifampin (Rifadin, Rimactane)

 

These agents are used to treat tuberculous epididymo-orchitis

Isoniazid (Laniazid, Nydrazid)

 

This is an isonicotinic acid hydrazide (INH), which is part of the triple-drug regimen.

Pyrazinamide

 

Pyrazinamide is a pyrazine analog of nicotinamide that may be bacteriostatic or bactericidal against M tuberculosis, depending on the concentration of the drug attained at the site of infection. Its mechanism of action is unknown. Pyrazinamide is part of the triple-drug regimen.

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Contributor Information and Disclosures
Author

Christina B Ching, MD Clinical Assistant Professor, Division of Pediatric Urology, Nationwide Children's Hospital

Christina B Ching, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Student Association/Foundation, American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Erik T Goluboff, MD Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; Director of Urology, Allen Pavilion, New York Presbyterian Hospital

Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, Society for Basic Urologic Research

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Michael Franks, MD, and Badrinath R Konety, MD, to the development and writing of the source article.

References
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  14. [Guideline] 2015 Sexually Transmitted Diseases Treatment Guidelines: Epididymitis. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/tg2015/epididymitis.htm. Accessed: December 19, 2015.

  15. Chung JH, Moon HS, Choi HY, et al. Inhibition of Adhesion and Fibrosis Improves the Outcome of Epididymectomy as a Treatment for Chronic Epididymitis: a multicenter, randomized, controlled, single blind study. J Urol. 2012 Dec 3. [Medline].

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Cross-section illustration of a testicle and epididymis. A: Caput or head of the epididymis. B: Corpus or body of the epididymis. C: Cauda or tail of the epididymis. D: Vas deferens. E: Testicle. Illustration by David Schumick, BS, CMI. Reprinted with the permission of the Cleveland Clinic Center for Medical Art and Photography © 2009. All Rights Reserved.
Color Doppler sonogram of the left epididymis in a patient with acute epididymitis. The image demonstrates increased blood flow in the epididymis resulting from the active inflammation.
Scrotal sonogram demonstrating the presence of a hydrocele and an enlarged epididymis in a patient with epididymitis. The echogenic white area is the normal testicle surrounded by the hydrocele.
Scrotal sonogram showing the testes adjacent to the inflamed epididymis with a reactive hydrocele.
 
 
 
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