User Tools

Site Tools


epididymo-orchitis

epididymo-orchitis

introduction

Mx of suspected epididymo-orchitis in the ED

  • in adolescents and younger men, one must first exclude possible torsion of the testes - consider urgent surgical consult within 1 hour in at risk patients, in very low risk patients an ultra-sound examination may be indicated.
  • send MSU m/c/s in all patients
  • consider sending urethral swab or 1st pass urine for Chlamydia and Gonococcal PCR in sexually active men

probable UTI cause

  • NB. the following are derived from ATG 2012 1) but do not cover Pseudomonas aeruginosa or enterococci.

mild-moderate infection

  • trimethoprim 300 mg (child: 6 mg/kg up to 300 mg) orally, daily for 14 days, or,
  • cephalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly for 14 days, or,
  • amoxycillin+clavulanate 500+125 mg (child: 12.5+3.1 mg/kg up to 500+125 mg) orally, 12-hourly for 14 days, or,
  • if resistance is suspected in adults, norfloxacin 400 mg orally, 12-hourly for 14 days.

severe infection

  • gentamicin 4 to 6 mg/kg (see Table 2.24) (child less than 10 years: 7.5 mg/kg; 10 years or more: 6 mg/kg) IV, for 1 dose, then determine dosing interval for a maximum of either 1 or 2 further doses based on renal function
  • PLUS
  • amoxycillin or ampicillin 2 g (child: 50 mg/kg up to 2 g) IV, 6-hourly.
  • in patients with HS to penicillins, gentamicin alone may be adequate, but if gentamicin contraindicated then:
    • ceftriaxone 1 g (child: 25 mg/kg up to 1 g) IV, daily

probable STD cause

  • ceftriaxone 500 mg in 2 mL of 1% lignocaine IM, or 500 mg IV, daily for 3 days (for gonorrhoea)
  • PLUS
  • PLUS EITHER:
epididymo-orchitis.txt · Last modified: 2013/11/26 16:35 (external edit)