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BACKGROUND: Acute epididymitis is a clinical syndrome consisting of pain, swelling, and inflammation of the epididymis that lasts less than 6 weeks. Although data has been proposed indicating that most cases of acute epididymitis are due to viral illness, post-infectious, or idiopathic etiologies, antibiotics have remained the most commonly prescribed treatment for this condition. This literature review and data analysis aimed to determine what percentage of urinalyses and urine cultures were indicative of a true bacterial infection causing epididymitis. The percentage of patients treated with antibiotics was then evaluated.
METHODS: A data analysis based on a comprehensive review of the literature in the EBSCO database was performed. A search of EBSCO through January 13, 2016 using the keywords epididymitis or epididymo-orchitis and child or children or pediatric, identified 542 potential studies. 27 retrospective studies met inclusion criteria. These studies included pediatric patients diagnosed with acute epididymitis or acute epididymo-orchitis in the outpatient and/or hospital setting less than or equal to 21 years of age. The studies included percentage of patients with positive urine cultures, urinalyses, and number of patients treated with antibiotics. Data was abstracted by the author. The reviewer decided which studies met inclusion criteria and evaluated study quality.
RESULTS: There were 1,496 patients diagnosed with acute epididymitis identified across 27 retrospective studies. A urinalysis was obtained for 1,124 patients. Of these, 190 (16.9%) were found to be positive. A urine culture was obtained for 670 patients. Of these, 100 (14.9%) were positive. Fourteen of the retrospective studies addressed antibiotic administration, out of 652 patients with acute epididymitis, 554 (85%) received treatment with antibiotics.
Across ten studies containing 502 patients with documentation of urinalysis results, urine culture results, and antibiotic treatment rates, 57 (11.3%) were found to be positive for a bacterial source causing epididymitis. However, 410 of the 502 (81.7%) patients in these ten studies received antibiotic therapy. This discrepancy between the number of patients with labs reflecting a bacterial etiology and the high rates of antibiotic prescriptions was found to be statistically significant.
CONCLUSIONS: Practitioners should consider only prescribing antibiotics to patients with acute epididymitis or acute epidydimo-orchitis if there is a abnormal urinalysis, positive urine culture, or for patients at risk for serious bacterial illnesses, such as infants less than four weeks of age or immunocompromised patients.