# Epididymo-orchitis (Acute) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Ceftriaxone — 1000 mg — injection - Referral & safety-netting (no drug therapy) - Levofloxacin — 500 mg — oral.solid - Doxycycline — 100 mg — oral.solid - Azithromycin — 500 mg — oral.solid ## Complete treatment card ```text EPIDIDYMO-ORCHITIS (ACUTE) 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 Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Epididymitis" - disease-level clinical article Status 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 1. CEFTRIAXONE [1st line] Adult 1 g IM single dose PLUS Doxycycline 100 mg BID for 14 days for sexually transmitted acute epididymo-orchitis - single IM dose Peds Specialist pediatric urology management AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. 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. Caution 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. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 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 ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution RED FLAG - Urgent referral and urological evaluation are needed to rule out testicular torsion, a surgical emergency, in acute scrotal pain. 3. LEVOFLOXACIN [2nd line] Adult 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 Peds Contraindicated in growing children AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. 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. Caution Obtain urine culture before starting fluoroquinolone therapy. There is a risk of tendinitis, tendon rupture, and QT prolongation. Egypt 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 PHARM... 27.00 EGP (5.40/unit) EXACINOP 500 MG 10 F.C.TABS. EL-OBOUR > MA... 65.00 EGP (6.50/unit) ROYAFLOXACIN 500 MG 10 F.C.TABS. MEDIZEN PHARM... 92.00 EGP (9.20/unit) TAVIXINOR 500 MG 5 F.C. TABS. MASH PREMIERE... 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 PHARM... 70.00 EGP 4. DOXYCYCLINE [add-on - not a substitute] Adult 100 mg twice daily for 14 days co-administered with Ceftriaxone x 14 days Peds Not recommended under 8 years of age due to tooth discoloration 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. Caution Take with a full glass of water and remain upright for 30 minutes to prevent esophageal ulceration. There is a photosensitivity risk with doxycycline. Egypt 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 P... 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 PHARMAC... 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 5. AZITHROMYCIN [add-on - not a substitute] Adult 1 g by mouth as a single dose - Single dose Peds 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. 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. Caution 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. Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 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 ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)