From the Guidelines
Bursitis should be treated with oral antibiotics for mild to moderate cases, and intravenous antibiotics for severe cases, with the goal of transitioning to oral therapy as soon as possible, as recommended by the 2018 WSES/SIS-E consensus conference 1. When deciding between oral and intravenous antibiotics for bursitis, the severity of the infection is the key factor.
- For mild to moderate septic bursitis, oral antibiotics such as dicloxacillin, cephalexin, or clindamycin are typically the first-line treatment, with a duration of 7-14 days.
- For more severe cases, particularly those with systemic symptoms, extensive cellulitis, or immunocompromised patients, intravenous antibiotics such as cefazolin, vancomycin, or ampicillin-sulbactam are recommended. The choice of antibiotic should target Staphylococcus aureus, the most common causative organism, though coverage may need to be broadened based on clinical circumstances, as outlined in the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1. In addition to antibiotics, treatment should include rest, elevation, ice application, and possibly drainage of the infected bursa.
- Patients should be monitored for improvement within 48-72 hours, and antibiotic therapy may need adjustment based on culture results and clinical response.
- Once improvement is noted with IV antibiotics, patients can often be transitioned to oral therapy to complete a full 10-14 day course, as suggested by the 2018 WSES/SIS-E consensus conference 1.
From the Research
Bursitis Treatment Options
- Bursitis can be treated with antibiotics, either orally or intravenously, depending on the severity of the condition 2, 3, 4.
- Septic bursitis, in particular, requires prompt antibiotic treatment to prevent further complications 3, 4.
- The choice of antibiotic and route of administration may vary depending on the specific type of bursitis and the patient's overall health status 3, 5.
Antibiotic Administration
- Oral antibiotics may be sufficient for mild cases of septic bursitis, while intravenous antibiotics may be necessary for more severe cases 2, 3.
- Sequential intravenous administration of antibiotics, such as cefazolin, followed by oral antibiotics, such as clindamycin, may be an effective treatment approach for septic bursitis 3.
- The duration of antibiotic treatment should be based on the culture results of serial aspirations and the patient's clinical response to treatment 4.
Comparison of Treatment Approaches
- Nonsurgical management of olecranon bursitis, including antibiotic treatment and aspiration, may be more effective and safer than surgical management 5.
- Corticosteroid injection for aseptic bursitis may be associated with increased complications and is not recommended as a first-line treatment 5.
- The choice of prophylactic antibiotics for surgical site infection prevention should be based on the patient's individual risk factors and the specific surgical procedure being performed 6.