Initial treatment for epididymitis includes analgesics, scrotal support, elevation, and bed rest Antibiotic use depends on the suspected etiology In sexually active adolescent males, in whom the most likely cause is chlamydia and gonorrhea, ceftriaxone (250 mg IM in single dose) plus doxycycline (100 mg PO twice a day for days) or azithromycin (1 g PO once) is recommended Due to increasing N gonorrhea resistance, quinolones are not recommended for routine treatment Patients allergic to cephalosporins and/or tetracyclines, or in whom enteric organisms are suspected, can be treated with fluoroquinolones such as ofloxacin or levofloxacin Of note, doxycycline use in younger children has been liberalized and can be administered for short durations (i.e., 21 days or less) without regard to the patient age Fluoroquinolones should not be used routinely as first-line agents in children younger than 18 years unless there is presence of a complicated urinary tract infection or no other alternatives exist In prepubertal boys epididymitis is most often viral or idiopathic Those with pyuria, positive urine cultures, or risk factors for urinary tract infection should be treated with antibiotic coverage for enteric organisms, such as trimethoprim-sulfamethoxazole or cephalexin The patient should be warned that this process is frustratingly slow to resolve and discomfort and scrotal swelling will gradually subside over a few weeks At any age when epididymitis is associated with a urinary tract infection and in all prepubertal boys with bacterial epididymitis, referral for urologic follow-up to rule out a structural problem is recommended