From the Guidelines
The management of acute prepatellar septic bursitis involves a combination of antibiotics, drainage, and supportive care, with the goal of reducing morbidity, mortality, and improving quality of life. The initial treatment should include empiric antibiotic therapy targeting Staphylococcus aureus, the most common causative organism, with medications such as cephalexin 500mg four times daily, dicloxacillin 500mg four times daily, or clindamycin 300-450mg four times daily for patients with penicillin allergy, as recommended by 1. Treatment duration typically ranges from 7-14 days. Needle aspiration of the bursa should be performed to obtain fluid for culture and sensitivity testing, which will guide definitive antibiotic therapy, as emphasized by 1. For large, tense, or highly symptomatic collections, serial aspirations may be necessary. Incision and drainage is reserved for cases with loculations, recurrent accumulation after aspiration, or treatment failure. Supportive measures include:
- Rest
- Elevation of the affected limb
- Application of ice
- Non-weight bearing or limited weight bearing with crutches if walking is painful. NSAIDs like ibuprofen 400-600mg three times daily can help manage pain and inflammation. Hospitalization with intravenous antibiotics (such as cefazolin 1-2g every 8 hours or vancomycin 15-20mg/kg every 12 hours) is indicated for patients with systemic symptoms, immunocompromise, or failed outpatient management, as suggested by 1. Close follow-up within 48-72 hours is essential to assess treatment response and adjust therapy if needed. It is crucial to prioritize source control, as highlighted by 1, and to consider patient factors that may impact efficacy, such as comorbidities and organ function. The selected antimicrobial agent should have activity against the identified or presumptive causative pathogen(s), known distribution to the site of infection, and proven therapeutic efficacy in the infection being treated. In general, for outpatient management, drugs that allow for infrequent dosing and rapid/bolus infusions are preferred, as noted by 1. However, if the resources exist to administer multiple doses of antimicrobials at home daily, efficacy should not be sacrificed for convenience. The management of acute prepatellar septic bursitis requires a comprehensive approach that takes into account the patient's overall health, the severity of the infection, and the need for prompt and effective treatment to reduce morbidity, mortality, and improve quality of life.
From the Research
Management of Acute Prepatellar Septic Bursitis
The management of acute prepatellar septic bursitis involves a combination of medical and surgical interventions.
- Initial management typically includes antibiotic therapy, with the route of administration (intravenous or oral) depending on the severity of the infection and the presence of systemic symptoms such as fever 2.
- Bursal aspiration is also a crucial component of management, allowing for the diagnosis of septic bursitis and the identification of the causative microorganism 2, 3.
- Surgical intervention, such as incision and drainage or bursectomy, may be necessary in cases of severe or refractory infection, but is generally reserved for cases that do not respond to medical management 2, 4, 3.
- The duration of antibiotic therapy is also an important consideration, with a treatment duration of less than 14 days associated with a higher risk of treatment failure 2.
Medical Management
Medical management of acute prepatellar septic bursitis typically involves the use of antibiotics, with the specific antibiotic regimen depending on the causative microorganism and the severity of the infection.
- The use of intravenous antibiotics may be preferred in cases of severe infection or systemic symptoms such as fever 2.
- The role of ultrasound-guided aspiration in the management of septic bursitis is also an important consideration, allowing for the accurate diagnosis and treatment of the infection 5.
Surgical Management
Surgical management of acute prepatellar septic bursitis is generally reserved for cases that do not respond to medical management, or in cases of severe or refractory infection.