From the Research
For suprapatellar bursitis requiring antibiotics, I recommend empiric therapy with cephalexin 500mg four times daily for 7-10 days as first-line treatment. This recommendation is based on the fact that Staphylococcus aureus is the most common cause of septic bursitis, and cephalexin is effective against this organism 1. Alternatives include clindamycin 300mg four times daily if penicillin allergy is present, or trimethoprim-sulfamethoxazole DS twice daily if MRSA is suspected. These antibiotics target common causative organisms like Staphylococcus aureus and Streptococcus species.
Treatment should be accompanied by:
- Rest
- Elevation
- Ice application for 20 minutes several times daily
- Non-steroidal anti-inflammatory drugs like ibuprofen 400-600mg three times daily for pain and inflammation If there's significant fluid collection, aspiration may be necessary both for diagnostic purposes and symptom relief. Patients should seek immediate medical attention if symptoms worsen, fever develops, or if there's increasing redness, warmth or streaking from the area. Antibiotic therapy should be adjusted based on culture results if fluid is aspirated. Complete resolution typically requires 1-2 weeks of treatment 2.
It's worth noting that the duration of antibiotic therapy may not be as critical as previously thought, with one study suggesting that short-course adjuvant antibiotic therapy (less than or equal to 7 days) is not a risk factor for recurrence in adult hospitalized patients 2. However, this should be balanced with the need to ensure complete resolution of the infection, and treatment should be individualized based on the patient's response and the results of any cultures obtained.
In terms of specific evidence, a study from 2017 provides guidance on the management of superficial bursitis, including the use of antibiotics for septic bursitis 1. Another study from 2011 discusses the diagnosis and management of four common types of bursitis, including prepatellar and olecranon bursitis, and highlights the importance of distinguishing between septic and non-septic bursitis 3. Overall, the key to successful treatment of suprapatellar bursitis is prompt recognition of the condition, appropriate antibiotic therapy, and adjunctive measures to reduce pain and inflammation.