Septic bursitis, olecranon, prepatellar
Absence of pain with joint movement may help differentiate septic bursitis from septic arthritis.
Recommend:
- Blood cultures if systemically ill.
- Baseline and follow-up x-rays to rule out bone or joint involvement.
- Aspirate fluid initially for drainage and C&S, and aspirate daily until fluid sterile and no longer accumulating.
- For chronic bursitis consider mycobacterial infection; send fluid or tissue for mycobacterial culture.
- In patients who fail to respond to antibiotic therapy and percutaneous drainage, surgical drainage and/or bursectomy may be required.
Usual Pathogens
S. aureus/MRSA
Group A Streptococci
Mild
Empiric Therapy | Duration | |
---|---|---|
Cephalexin | 500mg PO qid |
Cephalexin allergy
Empiric Therapy | Duration | |
---|---|---|
Cefuroxime axetil | 500mg PO bid | 2-3 weeks |
MRSA suspected
Empiric Therapy | Dose | Duration |
---|---|---|
Add to above regimens: |
||
TMP/SMX | 2 DS tabs PO bid | |
or | ||
Doxycycline | 100mg PO bid | 2-3 weeks |
Moderate-severe
Empiric Therapy | Duration | |
---|---|---|
Cefazolin | 2g IV q8h | |
or | ||
Cloxacillin | 2g IV q4h |
Cefazolin allergy/MRSA suspected
Empiric Therapy | Duration | |
---|---|---|
Vancomycin | 15mg/kg IV q12h |