Medication Summary
No medications are indicated for the treatment of viral orchitis.
Bacterial orchitis or epididymo-orchitis requires appropriate antibiotic coverage for suspected infectious agents. In patients with a bacterial etiology who are younger than 35 years and sexually active, antibiotic coverage for sexually transmitted pathogens (particularly gonorrhea and chlamydia) with ceftriaxone[6] and either doxycycline[6] or azithromycin is appropriate. Fluoroquinolones are no longer recommended by the Centers for Disease Control and Prevention (CDC) for treatment of gonorrhea because of resistance. For more information see, CDC updated gonococcal treatment recommendations (April 2007).
Patients older than 35 years with bacterial etiology require additional coverage for other gram-negative bacteria with a fluoroquinolone or TMP-SMX. Other appropriate medications include analgesics or antiemetics, as needed.
Antibiotics
Class Summary
Therapy must cover all likely pathogens in the context of the clinical setting.
Ceftriaxone (Rocephin)
Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. Used because of an increasing prevalence of penicillinase producing Neisseria gonorrhoeae.
Doxycycline (Vibramycin, Doryx)
Inhibits protein synthesis and bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Used in combination with ceftriaxone for the treatment of gonorrhea.
Azithromycin (Zithromax)
Treats mild-to-moderate infections caused by susceptible strains of microorganisms.
Indicated for chlamydia and gonorrheal infections of the genital tract.
Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Commonly used in patients >35 y with orchitis.
Ofloxacin (Floxin)
Penetrates prostate well and is effective against C trachomatis. A pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. Used commonly in patients >35 y diagnosed with orchitis.
Ciprofloxacin (Cipro)
Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, S epidermidis, and most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis and consequently growth. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared. Used commonly in patients >35 y diagnosed with orchitis.
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