Bursitis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Prepatellar Bursitis=== | ===Prepatellar Bursitis=== | ||
* '''Septic prepatellar bursitis''' requires oral antibiotics with or without surgical excision of the bursal sac (bursectomy) depending on the patient's response and the organism involved. | |||
* '''Septic prepatellar bursitis''' requires oral antibiotics with or without surgical excision of the bursal sac (bursectomy) depending on the patient's response and the organism involved. | * ''Staphylococcus aureus'' bursitis often resolves with antibiotics alone, while ''Sporotrix schenckii'' bursitis often requires bursectomy. | ||
* Most patients respond to oral antibiotics alone although some require intravenous therapy. | * Most patients respond to oral antibiotics alone although some require intravenous therapy. | ||
* '''Aseptic prepatellar bursitis''' is usually managed with rest, compression, and nonsteroidal anti-inflammatory drugs (NSAIDs). Iee is not helpful except in the acute setting. | * '''Aseptic prepatellar bursitis''' is usually managed with rest, compression, and nonsteroidal anti-inflammatory drugs (NSAIDs). Iee is not helpful except in the acute setting. | ||
* Local corticosteroid injections may be used in some patients who do not respond to initial therapy. | * Local corticosteroid injections may be used in some patients who do not respond to initial therapy. <ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647 }} </ref> | ||
===Olecranon Bursitis=== | ===Olecranon Bursitis=== | ||
* The mainstay of therapy for '''acute traumatic''' or '''idiopathic olecranon bursitis''' is nonsurgical measures including ice, compressive dressings, and avoidance of aggravating activity. | |||
* Most patients improve significantly with these measures. | |||
* Aspiration should be performed among patients who do not respond to rule out possible infection. | |||
* Early aspiration (with or without corticosteroid injection) may be helpful among patients with bothersome fluid collections. | |||
* The mainstay of therapy for '''septic olecranon bursitis''' is fluid drainage, rest, and intravenous antibiotics.<ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647 }} </ref> | |||
===Trochanteric Bursitis=== | ===Trochanteric Bursitis=== | ||
Revision as of 14:16, 24 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical therapy for traumatic bursitis includes the RICE regimen (rest, ice, compression, elevation), anti-inflammatory agents such as Aspirin, Naproxen, or Ibuprofen, ultrasound therapy, and/or corticosteroid injections. Restriction of activity is encouraged to prevent further injury and promote healing. Antimicrobial therapy is administered for infectious bursitis.
Medical Therapy
Prepatellar Bursitis
- Septic prepatellar bursitis requires oral antibiotics with or without surgical excision of the bursal sac (bursectomy) depending on the patient's response and the organism involved.
- Staphylococcus aureus bursitis often resolves with antibiotics alone, while Sporotrix schenckii bursitis often requires bursectomy.
- Most patients respond to oral antibiotics alone although some require intravenous therapy.
- Aseptic prepatellar bursitis is usually managed with rest, compression, and nonsteroidal anti-inflammatory drugs (NSAIDs). Iee is not helpful except in the acute setting.
- Local corticosteroid injections may be used in some patients who do not respond to initial therapy. [1]
Olecranon Bursitis
- The mainstay of therapy for acute traumatic or idiopathic olecranon bursitis is nonsurgical measures including ice, compressive dressings, and avoidance of aggravating activity.
- Most patients improve significantly with these measures.
- Aspiration should be performed among patients who do not respond to rule out possible infection.
- Early aspiration (with or without corticosteroid injection) may be helpful among patients with bothersome fluid collections.
- The mainstay of therapy for septic olecranon bursitis is fluid drainage, rest, and intravenous antibiotics.[1]
Trochanteric Bursitis
Retrocalcaneal Bursitis
Antimicrobial Regimens
- Septic bursitis [2]
- 1. Staphylococcus aureus, methicillin-susceptible (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q4h
- Preferred regimen (2): Oxacillin 2 g IV q4h
- Preferred regimen (3): Dicloxacillin 500 mg PO qid
- 2. Staphylococcus aureus, methicillin-resistant (MRSA)
- Preferred regimen (1): Vancomycin 1 g IV q12h
- Preferred regimen (2): Linezolid 600 mg PO qd
References
- ↑ 1.0 1.1 Aaron DL, Patel A, Kayiaros S, Calfee R (2011). "Four common types of bursitis: diagnosis and management". J Am Acad Orthop Surg. 19 (6): 359–67. PMID 21628647.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.