A second prospective study was a one-year prospective study in prepubescent males and excluded sexually active boys.¹⁰ The patients were 2–14 years of age. All patients with epididymitis (n=44) were diagnosed via US and admitted. Only 3 of 44 (6.8 percent) received antibiotics, with the remainder receiving “analgesics and bed rest.” All patients were followed up through symptom resolution. Only three patients had “mild pyuria” (3–5 WBC/hpf), and one patient had a positive urine culture. The authors state, “During follow up, no testicular abnormality and no symptom recurrence were noted.”

Conclusion: In prepubescent boys with acute epididymitis, antibiotics are probably not routinely indicated unless the UA or urine culture is positive. In postpubertal or sexually active boys with epididymitis, antibiotics treatment may be practitioner-specific since many studies on acute epididymitis commonly exclude these patients.

Dr. Jones is assistant professor of pediatric emergency medicine at the University of Kentucky in Lexington.

Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Poison Control Center at Upstate Medical University in Syracuse, New York.

References

1. Goldman RD, Friedman JN, Parkin PC. Validation of the clinical dehydration scale for children with acute gastroenteritis. Pediatrics. 2008;122(3):545-549.
2. Madati PJ, Bachur R. Development of an emergency department triage tool to predict acidosis among children with gastroenteritis. Pediatr Emerg Car. 2008;24(12):822-830.
3. Freedman SB, DeGroot JM, Parkin PC. Successful discharge of children with gastroenteritis requiring intravenous rehydration. J Emerg Med. 2014; 46(1):9-20.
4. Sakellaris GS, Charissis GC. Acute epididymitis in Greek children: a 3-year retrospective study. Eur J Pediatr. 2008;167(7):765-769.
5. Graumann LA, Dietz HG, Stehr M. Urinalysis in children with epididymitis. Eur J Pediatr Surg. 2010;20(4):247-249.
6. Santillanes G, Gausche-Hill M, Lewis RJ. Are antibiotics necessary for pediatric epididymitis? Pediatric Emerg Care. 2011;27(3):174-178.
7. Joo JM, Yang SH, Kang TW et al. Acute epididymitis in children: the role of the urine test. Korean J Urol. 2013;54(2):135-138.
8. Cristoforo TA. Evaluating the necessity of antibiotics in the treatment of acute epididymitis in pediatric patients: a literature review of retrospective studies and data analysis (published online ahead of print Jan. 17, 2017). Pediatr Emerg Care.
9. Lau P, Anderson PA, Giacomantonio JM, et al. Acute epididymitis in boys: are antibiotics indicated? Br J Urol. 1997;79(5):797-800.
10. Somekh E, Gorenstein A, Serour F. Acute epididymitis in boys: evidence of a post-infectious etiology. J Urol. 2004;171(1):391-394.