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.
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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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.
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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.
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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.
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Scrotal sonogram showing the testes adjacent to the inflamed epididymis with a reactive hydrocele.
