Sections

Orchitis

Medication

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^[3]and either doxycycline^[3]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 trimethoprim-sulfamethoxazole. Other appropriate medications include analgesics or antiemetics, as needed.

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

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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)

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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)

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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)

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Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Commonly used in patients >35 y with orchitis.

Ofloxacin (Floxin)

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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)

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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.

Questions

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Author

Nataisia Terry, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Nataisia Terry, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Walter W Valesky, Jr, MD Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

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.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

Acknowledgements

Mark B Mycyk, MD Associate Professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine

Mark B Mycyk, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Orchitis Medication

Medication Summary

Antibiotics

Class Summary

Ceftriaxone (Rocephin)

Ceftriaxone (Rocephin)

Doxycycline (Vibramycin, Doryx)

Doxycycline (Vibramycin, Doryx)

Azithromycin (Zithromax)

Azithromycin (Zithromax)

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS)

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS)

Ofloxacin (Floxin)

Ofloxacin (Floxin)

Ciprofloxacin (Cipro)

Ciprofloxacin (Cipro)

References

Tables

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