From the FDA Drug Label
For relief of the signs and symptoms of 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 initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
The treatment for olecranon bursitis is naproxen. The recommended dose is 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as needed. The total daily dose should not exceed 1250 mg initially and 1000 mg thereafter 1, 1.
From the Research
Treatment for olecranon bursitis should begin with conservative measures, including rest, ice application, compression, and elevation, as well as over-the-counter NSAIDs, with surgery reserved for cases that do not respond to conservative treatment or recur frequently. The initial approach to managing olecranon bursitis involves distinguishing between septic and non-septic bursitis, with the former requiring antibiotic therapy and the latter potentially benefiting from corticosteroid injections, although the evidence suggests that corticosteroid injections may increase the risk of complications without improving outcomes 2.
Key components of the conservative management include:
- Rest, ice application for 15-20 minutes several times daily
- Compression with an elastic bandage
- Elevation of the affected elbow
- Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily)
- Avoiding activities that put pressure on the elbow
- Protective padding may be recommended when returning to activities
For more severe cases or when infection is suspected, based on signs such as warmth, redness, fever, or purulent drainage, further interventions may be necessary:
- Aspiration of fluid from the bursa may be performed by a healthcare provider
- Antibiotics such as cephalexin (500mg four times daily for 7-10 days) or clindamycin (300mg four times daily for 7-10 days) are prescribed if infection is present
- Surgery (bursectomy) is considered for cases that do not respond to conservative treatment or recur frequently, with the understanding that surgical management may have higher rates of complications compared to non-surgical approaches 2, 3.
The most recent and highest quality study 4 supports the effectiveness of conservative management for olecranon bursitis, including the use of antibiotics for septic cases, and suggests that the success rate is equivalent in non-surgical and surgical management groups, although a treatment duration of less than 14 days may require special attention. Therefore, a stepped approach starting with conservative management and reserving more invasive interventions for complicated or recurrent cases is recommended, prioritizing the reduction of morbidity, mortality, and improvement of quality of life for patients with olecranon bursitis.