American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended antibiotic treatment for epididymitis?

1. Ceftriaxone and doxycycline

2. Azithromycin and ciprofloxacin

3. Amoxicillin and metronidazole

4. Gentamicin and cefazolin

The correct answer is: Ceftriaxone and doxycycline

The recommended antibiotic treatment for epididymitis, particularly in sexually active men under the age of 35, is a combination of ceftriaxone and doxycycline. This regimen is effective due to the commonly implicated organisms in this population, primarily Chlamydia trachomatis and Neisseria gonorrhoeae. Ceftriaxone is a broad-spectrum cephalosporin that covers Neisseria gonorrhoeae effectively, while doxycycline, a tetracycline antibiotic, targets Chlamydia trachomatis. The combined approach is essential because it ensures coverage of both organisms, which are frequent causative pathogens in cases of epididymitis linked to sexual activity. This treatment recommendation aligns with clinical guidelines that address the need for coverage of typical pathogens while considering the patient's demographic and risk factors. The use of this combination not only facilitates effective treatment but also helps prevent potential complications associated with untreated infections, such as infertility. Other options, while they may be antibiotics used for different conditions, do not provide the optimal coverage for the organisms usually responsible for epididymitis in the specified patient population.