Analgesia and anti-inflammatory
›Analgesia and anti-inflammatory
›NSAIDs
›Ibuprofen PO
›400 mg every 6 hours
›Maximum 2400 mg per day
›Naproxen PO
›500 mg then 250 mg every 6 to 8 hours
›Maximum 1250 mg per day
›Acetaminophen
›650 mg every 6 hours
›Maximum 3000 mg per day
›Opioid for breakthrough pain
›Morphine PO
›5 mg to 10 mg every 4 hours as needed
›Avoid if respiratory depression risk
›Antibiotics
›Suspected STI-associated orchitis or epididymo-orchitis
›Ceftriaxone IM single dose
›500 mg once
›If weight >=150 kg, 1 g once
›Doxycycline PO course
›100 mg twice daily for 10 days
›Evidence basis
›CDC STI Treatment Guidelines epididymitis regimen
›Suspected STI plus enteric pathogens risk
›Ceftriaxone IM single dose
›500 mg once
›If weight >=150 kg, 1 g once
›Levofloxacin PO course
›500 mg once daily for 10 days
›Evidence basis
›CDC STI Treatment Guidelines epididymitis regimen
›IUSTI European guideline supports dual coverage when both STI and enteric risk
›Suspected enteric pathogens without STI risk
›Levofloxacin PO course
›500 mg once daily for 10 days
›Ofloxacin PO course
›300 mg twice daily for 10 days
›Culture-directed alternatives
›Trimethoprim-sulfamethoxazole DS PO
›1 tablet twice daily for 10 to 14 days
›Use only if organism susceptible
›Stewardship notes
›Avoid ciprofloxacin due to reduced recommendation in European guidance
›Severe infection or sepsis physiology
›If unstable, initiate broad-spectrum IV antibiotics per local urosepsis pathway
›Piperacillin-tazobactam IV
›4.5 g every 6 to 8 hours
›Ceftriaxone IV
›2 g daily
›Add vancomycin IV if MRSA risk or necrotizing infection concern
›Weight-based dosing per local protocol
Viral orchitis including mumps
›Viral orchitis including mumps
›Supportive management
›Bed rest
›Scrotal support
›Analgesic and anti-inflammatory therapy
›Corticosteroids
›Short-term pain reduction possible
›No proven prevention of testicular atrophy or altered clinical course
›Antivirals
›No specific antiviral therapy for mumps orchitis
Procedural and consultation triggers
›Procedural and consultation triggers
›Urology consult indications
›Torsion not excluded
›Abscess on ultrasound
›Testicular infarction concern
›Failure to improve within 48 to 72 hours on appropriate therapy
›Surgical emergency indications
›Fournier gangrene concern
›Incarcerated hernia concern