From the Research
Doxycycline is not typically recommended as a first-line treatment for olecranon bursitis unless there is clear evidence of infection. For infected (septic) olecranon bursitis, broader spectrum antibiotics that cover Staphylococcus aureus are usually preferred, such as cephalexin 500mg four times daily or dicloxacillin 500mg four times daily for 7-10 days 1. If MRSA is suspected, trimethoprim-sulfamethoxazole or clindamycin may be more appropriate. Doxycycline 100mg twice daily could be considered as an alternative if the patient has allergies to first-line options or based on local resistance patterns.
Key Considerations
- Most cases of olecranon bursitis are non-infectious and should be treated with rest, ice, compression, elevation, and NSAIDs rather than antibiotics 2.
- Treatment should also include aspiration of the bursa if there is significant fluid collection, and possibly a corticosteroid injection for non-infectious cases.
- Antibiotics should only be used when infection is present, which is typically indicated by warmth, significant erythema, fever, or purulent drainage.
- If infection is suspected, fluid should be aspirated and sent for culture before starting antibiotics to guide appropriate therapy.
Recent Evidence
A recent study published in 2024 found that intrabursal doxycycline sclerotherapy was safe and effective for recurrent olecranon bursitis, with high patient satisfaction and no ultimate recurrence of bursitis at the final follow-up 3. However, this study was focused on recurrent cases and not initial treatment.
Treatment Approach
Given the available evidence, the treatment approach for olecranon bursitis should prioritize non-infectious cases with conservative management, reserving antibiotics for cases with clear evidence of infection. Doxycycline may be considered in specific scenarios, but its use should be guided by clinical judgment and suspicion of infection, rather than as a first-line treatment for all cases of olecranon bursitis.