What antibiotics cover Streptococcus (strep) and Staphylococcus (staph) for bursitis?

Antibiotic Treatment for Streptococcal and Staphylococcal Bursitis

For bursitis caused by Streptococcus and Staphylococcus, first-line antibiotic treatment should be clindamycin (300-450 mg PO TID for adults) or trimethoprim-sulfamethoxazole (1-2 double-strength tablets PO BID for adults) for 7-10 days. 1

Pathogen Considerations

Bursitis is inflammation of the fluid-filled sacs (bursae) that cushion joints. When infected:

• Staphylococcus aureus is the most common pathogen, accounting for approximately 80% of all septic bursitis cases 2
• Streptococcal species are less common but still significant pathogens
• Mixed infections can occur with both pathogens present simultaneously 3

Antibiotic Selection Algorithm

For Outpatient Treatment (Mild to Moderate Bursitis):

1. First-line options:

   • Clindamycin: 300-450 mg PO TID for adults (10-13 mg/kg/dose PO every 6-8 hours for children) 1
   • TMP-SMX: 1-2 double-strength tablets PO BID for adults (trimethoprim 4-6 mg/kg/dose PO every 12 hours for children) 1
   • Dicloxacillin or cephalexin: 500 mg PO QID 3

2. Alternative options (if allergies or contraindications exist):

   • Doxycycline: 100 mg PO BID (for patients ≥8 years old) 1
   • Linezolid: 600 mg PO BID (for MRSA infections or when other options fail) 3, 1

For Inpatient Treatment (Severe or Complicated Bursitis):

1. First-line options:

   • Vancomycin: 15-20 mg/kg/dose IV every 8-12 hours (target trough 15-20 μg/mL) 3, 1, 4
   • Clindamycin: 600 mg IV TID (if susceptibility confirmed) 1, 5

2. Alternative options:

   • Daptomycin: 4 mg/kg/dose IV once daily 1
   • Linezolid: 600 mg IV BID 3, 1
   • Cefazolin: 1-2 g IV every 8 hours (for MSSA only) 3, 6

Duration of Treatment

• Uncomplicated bursitis: 7-10 days 1
• Complicated bursitis: 14 days or longer based on clinical response 3, 1

Special Considerations

MRSA Coverage

If MRSA is suspected or confirmed:

• Vancomycin, linezolid, clindamycin, daptomycin, or TMP-SMX should be used 3, 1
• Avoid β-lactams unless susceptibility is confirmed 6

Penicillin Allergies

For patients with penicillin allergies:

• Clindamycin is the preferred alternative for both streptococcal and staphylococcal infections 5, 6
• For non-immediate hypersensitivity reactions, cephalosporins may be used 6
• For immediate hypersensitivity reactions (anaphylaxis), avoid cephalosporins and use clindamycin, TMP-SMX, or linezolid 6

Management Pearls

• Incision and drainage is essential for purulent bursitis and should accompany antibiotic therapy 1, 7
• Bursal aspiration should be performed if infection is suspected to guide antibiotic selection 7, 8
• Fluid should be sent for Gram stain, culture, cell count, crystal analysis, and glucose measurement 7
• S. aureus accounts for approximately 80% of septic bursitis cases, with the olecranon and prepatellar bursae most commonly affected 8, 2

Common Pitfalls to Avoid

1. Failing to aspirate suspected septic bursitis - Aspiration is crucial for diagnosis and treatment 7
2. Using monotherapy with rifampin or fusidic acid - Resistance develops rapidly; always use in combination 6
3. Overlooking MRSA possibility - Community-acquired MRSA is increasingly common 3, 6
4. Inadequate duration of therapy - Premature discontinuation can lead to treatment failure 1
5. Missing underlying conditions - Inflammatory disorders like gout can mimic or coexist with septic bursitis 7

Wound Care and Prevention

• Keep draining wounds covered with clean, dry bandages 1
• Maintain good personal hygiene with regular bathing and hand cleaning 1
• Avoid reusing or sharing personal items that have contacted infected skin 1
• Consider decolonization with mupirocin nasal ointment and chlorhexidine body washes for recurrent infections 1