Antibiotic Treatment for Bursitis

Introduction to Antibiotic Treatment

The Infectious Diseases Society of America recommends vancomycin (15mg/kg every 12 hours IV) as an alternative to cloxacillin for patients with septic bursitis, particularly those who are penicillin-allergic 1, 2
The Infectious Diseases Society of America suggests that antibiotics should be administered intravenously initially, then switched to oral once clinical improvement occurs, with a total duration of 2-3 weeks 2

For septic bursitis, the American College of Physicians recommends cloxacillin/flucloxacillin as the first-line treatment, with vancomycin as an alternative for penicillin-allergic patients 1, 2
The Infectious Diseases Society of America recommends vancomycin (15mg/kg every 12 hours IV) or clindamycin (600-900mg every 8 hours IV) for patients with septic bursitis who are penicillin-allergic 1, 2, 3

For immunocompromised patients or those with open trauma to the area, the Infectious Diseases Society of America recommends adding an agent active against enteric gram-negative bacilli, such as ampicillin-sulbactam, piperacillin-tazobactam, or a carbapenem 2, 3
For polymicrobial infections, the Infectious Diseases Society of America suggests broader coverage with antibiotics such as ceftriaxone plus metronidazole, or ciprofloxacin plus metronidazole 3

Administer 12 g/day IV in 4-6 divided doses initially, as recommended by the Infectious Diseases Society of America 4
For penicillin-allergic patients, use vancomycin 15 mg/kg IV every 12 hours or clindamycin 600-900 mg IV every 8 hours, as suggested by the Clinical Infectious Diseases guidelines 4

If MRSA is suspected or confirmed, vancomycin remains the standard choice, according to the Clinical Infectious Diseases guidelines 4, 5
Alternative options for MRSA include linezolid 600 mg IV/PO twice daily or daptomycin 4 mg/kg/dose IV daily, as recommended by the Infectious Diseases Society of America 5
Clindamycin 600-900 mg IV every 8 hours is acceptable if the isolate is susceptible, as suggested by the Clinical Infectious Diseases guidelines 5

Do not use rifampin as monotherapy or routine adjunctive therapy for bursitis, as it is not recommended for skin and soft tissue infections by the Infectious Diseases Society of America 5

The Infectious Diseases Society of America recommends dicloxacillin (500 mg orally four times daily) or cephalexin (500 mg orally three times daily) as first-line oral antibiotics for infectious bursitis in patients without MRSA risk factors, as these agents target methicillin-sensitive S. aureus (MSSA), which accounts for approximately 80-85% of septic bursitis cases 6, 7
Dicloxacillin and cephalexin provide excellent anti-staphylococcal activity and are recommended for purulent skin and soft tissue infections, which share similar microbiology with infectious bursitis 6, 7

For patients with MRSA risk factors, the Infectious Diseases Society of America recommends oral agents with MRSA activity, such as trimethoprim-sulfamethoxazole (160-800 mg twice daily), doxycycline (100 mg twice daily), or clindamycin (300 mg three times daily) 6, 7

For immunocompromised patients or those with open trauma to the bursa, the Infectious Diseases Society of America recommends adding coverage for enteric gram-negative bacilli with agents such as amoxicillin-clavulanate (875 mg twice daily) or fluoroquinolones (ciprofloxacin 500-750 mg twice daily or levofloxacin 500-750 mg daily) 6, 7