From the FDA Drug Label
Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. 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 considerations for outpatient treatment of olecranon bursitis include:
- Pain management: Naproxen can be used for the management of acute painful conditions, 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.
- Dose adjustment: The dose and frequency of naproxen should be adjusted to suit an individual patient's needs, taking into account factors such as renal or hepatic impairment, or elderly patients 1.
- Monitoring for adverse events: Patients should be monitored for signs or symptoms of GI bleeding, and laboratory tests such as CBC and chemistry profile should be checked periodically 2.
From the Research
Outpatient treatment of olecranon bursitis should begin with conservative measures, including rest, ice application, compression, and elevation (RICE) of the affected elbow, as well as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 7-14 days. The goal of treatment is to reduce pain and inflammation, prevent complications, and improve quality of life. Key considerations for treatment include:
- Avoiding activities that put pressure on the elbow
- Using an elbow pad to protect the bursa from further trauma
- Prescribing empiric oral antibiotics covering Staphylococcus aureus, such as cephalexin or clindamycin, for 7-10 days in cases of septic bursitis 3
- Aspiration may be necessary for diagnostic purposes or to provide symptomatic relief, particularly when the bursa is significantly distended or if infection is suspected
- Corticosteroid injections, such as methylprednisolone, may be considered for non-infectious cases that don't respond to conservative treatment, though this carries a risk of infection and skin atrophy 4 Patients should be instructed to return for follow-up in 48-72 hours if receiving antibiotics, or sooner if symptoms worsen. Surgical intervention is rarely needed in the outpatient setting but may be considered for recurrent or refractory cases. According to a recent systematic review, conservative methods can lead to clinical resolution of aseptic olecranon bursitis if implemented earlier in the disease course 4. Additionally, a study found that empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis 3. It's essential to weigh the benefits and risks of each treatment option and consider the individual patient's needs and circumstances. Overall, the treatment of olecranon bursitis should prioritize reducing morbidity, mortality, and improving quality of life, and the most recent and highest-quality evidence should guide treatment decisions 4, 3.