infectious

Epididymo-orchitis (Acute)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Egyptian National Drug Formulary - Antimicrobial 2023 · BASHH UK National Guideline for the Management of Epididymo-orchitis 2020 · EAU Guidelines on Urological Infections 2023 · Azithromycin DailyMed label, SetID 01649d79-4677-4577-a3e4-e054f3f9fc3b, section 2

Verified against4 documents

Egyptian National Drug Formulary - Antimicrobial 2023
BASHH UK National Guideline for the Management of Epididymo-orchitis 2020
EAU Guidelines on Urological Infections 2023
Epididymo-orchitis (Acute) - disease-level clinical article (epididymo-orchitis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

Scrotal pain and swelling usually develop gradually rather than acutely [testicular pain]
Pain may start in the flank and migrate down to the scrotum
Dysuria, urinary frequency, urgency, or incontinence may accompany the scrotal pain [burning on passing urine · testicular pain · urinary frequency]
Urethral discharge may also be reported [urethral discharge]

Signs — what you find (5)

Tenderness over the posterosuperior epididymis on palpation is the hallmark exam finding
Testicular tenderness itself points toward epididymo-orchitis or orchitis rather than epididymitis alone [testicular pain]
Overlying scrotal skin may be warm, red, and indurated from infection
Tender inguinal lymph nodes may be present
Exam may show urethral discharge and tenderness of the prostate on digital rectal exam [urethral discharge]

Tests (5)

Urinalysis showing red and white blood cells suggests an infectious or inflammatory process
Urine culture identifies the causative organism when a urinary tract infection is present
A urethral swab is indicated when the sexual history suggests a possible sexually transmitted infection
Doppler ultrasound assesses both testicular anatomic structure and blood flow
Ultrasound can directly show inflammation of the epididymis and testis

If not this — what else fits (11)

Testicular torsion causes abrupt pain, unlike the gradual onset typical of epididymitis
Epididymal congestion following vasectomy
Hydrocele
Orchitis
Referred or radicular pain
Scrotal trauma
Spermatocele
Testicular trauma
Testicular seminoma
Tunica vaginalis tumor
Urinary tract infection

SourceStatPearls "Epididymitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | If doxycycline is not tolerated - given with ceftriaxone

MAIN TREATMENT - choose one, plus any add-on marked below

CEFTRIAXONE

1st line

Strength1000 mg

Forminjection

Adult dose and duration

1 g IM single dose PLUS Doxycycline 100 mg BID for 14 days for sexually transmitted acute epididymo-orchitis - single IM dose

Paediatric dose

Specialist pediatric urology management

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph), General Adult Dosage: "IV or IM 1-2 g once or devided twice daily", 1 gm vial; the sexually-transmitted epididymo-orchitis regimen is from the BASHH UK National Guideline for the Management of Epididymo-orchitis 2020, which is not held in this corpus.

Why

Cephalosporin that covers Neisseria gonorrhoeae, given together with doxycycline for chlamydia coverage, in sexually transmitted acute epididymo-orchitis.

Cautions

ALWAYS rule out testicular torsion urgently in any young male presenting with acute scrotal pain.
Provide partner notification and STI screening for N. gonorrhoeae and C. trachomatis.
Reconstitute with 1% lidocaine for IM injection to reduce pain.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ZOXIDEL 1 GM PD. FOR I.M. INJ.	RAMEDA > DELTA PHARMA	22.00 EGP
CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)	KAHIRA	29.00 EGP
ZOXIDEL 1 GM PD. FOR I.V. INJ.	RAMEDA > DELTA PHARMA	29.00 EGP
WINTRIAXONE 1 GM PD. FOR I.V INJ.	SANOFI	48.00 EGP
VOTRIAXONE 1 GM I.M VIAL	CHEMIPHARM	56.00 EGP
OFRAMAX 1 GM I.M. VIAL	RAMEDA > SUN PHARMA EGYPT LIMITED	71.00 EGP
TRIAXONE 1 GM I.M. VIAL	TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA	106.00 EGP
TRIAXONE 1 GM I.V VIAL	TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA	106.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Epididymo-orchitis (Acute) - disease-level clinical article (epididymo-orchitis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Urgent referral and urological evaluation are needed to rule out testicular torsion, a surgical emergency, in acute scrotal pain.

LEVOFLOXACIN

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg once daily for 10-14 days when enteric organisms (E. coli) are suspected (age >35 years or post-urological procedure) x 10-14 days

Paediatric dose

Contraindicated in growing children

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (levofloxacin monograph): "Conventional dosing: Adult: Oral/IV :500-750 mg once daily". The enteric-organism indication and the 10-to-14-day course are from the EAU Guidelines on Urological Infections 2023, which is not held in this corpus.

Why

Fluoroquinolone used instead of the ceftriaxone-doxycycline regimen when enteric organisms such as E. coli are the likely cause, typically in older men or those with a recent urological procedure.

Cautions

Obtain urine culture before starting fluoroquinolone therapy.
There is a risk of tendinitis, tendon rupture, and QT prolongation.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FLOXABACT 500 MG 10 F.C.TABS.(NOW LEVOFLOXACIN-EVA)	EVA PHARMA	40.00 EGP (4.00/unit)
LEVOMAGICTAM 500 MG 5 F.C.TABS.	MEDIZEN PHARMACEUTICAL INDUSTRIES > MAGIC PHARMA-EGYPT	27.00 EGP (5.40/unit)
EXACINOP 500 MG 10 F.C.TABS.	EL-OBOUR > MASSA GROUP PHARMA	65.00 EGP (6.50/unit)
ROYAFLOXACIN 500 MG 10 F.C.TABS.	MEDIZEN PHARMACEUTICAL INDUSTRIES > SATO PHARMA	92.00 EGP (9.20/unit)
TAVIXINOR 500 MG 5 F.C. TABS.	MASH PREMIERE > SAS PHARMA	64.50 EGP (12.90/unit)
BIOWORLD 500 MG 10 F.C. TABS.	EGPI > BIOWORLD	133.00 EGP (13.30/unit)
TAVANIC 500 MG 5 F.C.TABS.	SANOFI	192.00 EGP (38.40/unit)
ALFASPECT 500 MG 5 S.F.C.TABS.	SPIMACO PHARMACEUTICAL INDUSTRIES > INNOGEN PHARMA	70.00 EGP

DOXYCYCLINE

add-on - not a substitute

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg twice daily for 14 days co-administered with Ceftriaxone x 14 days

Paediatric dose

Not recommended under 8 years of age due to tooth discoloration

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph): "Usual dosage range: Oral: IR and most ER formulations: 100 to 200 mg/day in 1 to 2 divided doses", 100 mg capsules; the 14-day epididymo-orchitis course is from the BASHH UK National Guideline for the Management of Epididymo-orchitis 2020, which is not held in this corpus.

Why

Adjunct antibiotic co-administered with ceftriaxone to cover Chlamydia trachomatis, the other major sexually transmitted cause of acute epididymo-orchitis; it does not treat gonococcal infection on its own.

Cautions

Take with a full glass of water and remain upright for 30 minutes to prevent esophageal ulceration.
There is a photosensitivity risk with doxycycline.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FARCODOXIN 100MG 10 CAPS.	PHARCO	11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.	ADWIA	12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.	GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE	12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.	EIPICO	23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.	EL NILE.	30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.	TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA	46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.	PFIZER	65.00 EGP (6.50/unit)

IF DOXYCYCLINE IS NOT TOLERATED - GIVEN WITH CEFTRIAXONE - give alongside

AZITHROMYCIN

If doxycycline is not tolerated - given with ceftriaxone

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g by mouth as a single dose - Single dose

Paediatric dose

Not applicable - sexually transmitted epididymo-orchitis is an adult and adolescent presentation, and no paediatric dose for it appears in the sources opened.

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Azithromycin DailyMed label, SetID 01649d79-4677-4577-a3e4-e054f3f9fc3b, section 2 - verbatim: "Non-gonococcal urethritis and cervicitis One single 1 gram dose."

Why

The card's chlamydial cover is a 10-day course of doxycycline; some men cannot take it and some will not finish it, and a single 1 g dose given in the clinic covers the same organism alongside the ceftriaxone injection they are already getting.

Cautions

It does not cover gonorrhoea at this dose - the ceftriaxone injection is still needed, not replaced.
Doxycycline remains the preferred partner for ceftriaxone; use azithromycin when doxycycline cannot be taken or ten days of adherence is unrealistic.
Treat the sexual partners and advise abstinence until both are treated, or the man will be back.
Azithromycin can prolong the QT interval; take care in cardiac disease or with other QT-prolonging drugs.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
AZATRIBACT 500MG 3 CAPS.	RIVA PHARMA S.A.E.	13.50 EGP (4.50/unit)
GIGAZOCIN 500MG 5 CAPS.	EGPI > PIONEER	27.50 EGP (5.50/unit)
SYSTYMYCIN 500MG 3 CAPS.	EGPI > NOVELL PHARMA	21.50 EGP (7.17/unit)
AZITHROMASH 500 MG 3 F.C. TABS.	MASH PREMIERE	48.00 EGP (16.00/unit)
AZALIDE 500MG 3 CAPS.	UP PHARMA	52.00 EGP (17.33/unit)
AZROLID 500 MG 6 F.C.TABS.	AMRIYA	126.00 EGP (21.00/unit)
ZERAMERATE 500 MG	EGPI > GAMMA PHARMA	28.50 EGP
DISTABCIN 500 MG 3 DISPERSIBLE TABS.	EGPI	43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solid	EL-OBOUR > AVERROES PHARMA-EGYPT	12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solid	ORGANO PHARMA > NOVELL PHARMA	12.75 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.