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Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients: A Literature Review of Retrospective Studies and Data Analysis
Poster Title: Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients: A Literature Review of Retrospective Studies and Data Analysis
Submitted on 08 Feb 2017
Author(s): Thomas Cristoforo
Affiliations: Univiersity of South Florida, Tampa General Hospital, Johns Hopkins All Children's Hospital
This poster was presented at USF Health Research Day 2017
Poster Views: 994
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Poster Information
Abstract: BACKGROUND: Acute Epididymitis (AE) 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 AE 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 AE 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 AE 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 AE, 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 AE 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.
Summary: Antibiotics in the treatment AE for pediatric patients with a confirmed bacterial etiology or patients at risk for serious bacterial illnesses.

A bacterial etiology should be confirmed with a positive urinalysis or positive urine culture.

Sexually active patients and adolescents should be tested for sexually transmitted infections, including Chlamydia and Gonorrhea
References: 1. Tracy CR, Steers WD, Costabile R. Diagnosis and management of
epididymitis. Urol Clin North Am. 2008;35:101–108.
2. 2010 STD Treatment Guidelines. Centers for Disease Control and
Prevention. Centers for Disease Control and Prevention, 28 January 2011.
Available at:
rr5912.pdf. Accessed May 30, 2016.
3. Pillai SB, Besner GE. Pediatric testicular problems. Pediatr Clin North Am.
4. Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in
the emergency department. J Pediatr Surg. 1995;30:277–281. discussion
5. Halachmi S, Katz N. Epididymo-orchitis in pre-pubertal children.
Epidemiology, etiology, management and follow-up recommendations.
Open J Urol. 2013;3:96–101.
6. Bukowski TP, Lewis AG, Reeves D, et al. Epididymitis in older boys:
dysfunctional voiding as an etiology. J Urol. 1995;154(2 Pt 2):762–765.
7. Graumann LA, Di
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