From the FDA Drug Label
For relief of the signs and symptoms of bursitis Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
The management of prepatellar bursitis may involve the use of naproxen with a recommended starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 1.
- The initial total daily dose should not exceed 1250 mg of naproxen.
- Thereafter, the total daily dose should not exceed 1000 mg of naproxen. Naproxen is indicated for the relief of the signs and symptoms of bursitis 1.
From the Research
Management of prepatellar bursitis should prioritize conservative approaches, including the RICE protocol, NSAIDs, and activity modification, with surgical intervention reserved for severe or refractory cases, as supported by the most recent and highest quality study 2. The initial treatment focuses on the RICE protocol: rest, ice application for 15-20 minutes several times daily, compression with an elastic bandage, and elevation of the affected leg. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for 1-2 weeks can help reduce pain and inflammation.
- Key aspects of management include:
- Activity modification to avoid kneeling or direct pressure on the affected knee
- Aspiration of the bursal fluid for significantly distended bursae or suspected infection
- Oral antibiotics for septic bursitis, such as cephalexin (500mg four times daily for 7-10 days) or clindamycin (300-450mg four times daily for 7-10 days)
- Corticosteroid injections, like methylprednisolone 40mg mixed with lidocaine, for recurrent or refractory cases, with caution due to the risk of infection
- Prevention strategies are also crucial, including the use of knee pads during activities that require kneeling and avoiding direct pressure on the anterior knee. According to 3, the differentiation between septic and non-septic bursitis is essential for guiding treatment, with septic cases requiring antibiotic therapy and non-septic cases potentially benefiting from intrabursal steroid injections. However, the most recent study 2 emphasizes the importance of conservative management, including the RICE protocol, in reducing postoperative swelling and promoting recovery. Thus, conservative management should be the first line of treatment for prepatellar bursitis, with more invasive approaches considered only when necessary, as indicated by the latest evidence 2.