Tenosynovitis Medication

The goals of tenosynovitis therapy are to reduce pain and eradicate infection.

Class Summary

Most commonly used for relief of mild to moderate pain. Although effects of NSAIDs in treatment of pain tend to be patient specific, ibuprofen usually is the DOC for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam. NSAIDs are primarily used for de Quervain and volar flexor tenosynovitis.

Ibuprofen (Motrin, Advil, Ibuprin, Nuprin)

Usually DOC for treatment of mild to moderate pain if no contraindications exist.

Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which results in inhibition of prostaglandin synthesis.

Naproxen (Anaprox, Naprelan, Naprosyn, Aleve)

Used for relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which results in prostaglandin synthesis.

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

Third-generation cephalosporin that has broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms.

By binding to 1 or more of the penicillin-binding proteins, it arrests bacterial cell wall synthesis and inhibits bacterial growth.

Used because of increasing prevalence of penicillinase producing N gonorrhoeae.

Spectinomycin (Trobicin)

Inhibits protein synthesis in bacterial cells. Site of action is 30S ribosomal subunit; structurally different from related aminoglycosides.

Used as alternative antimicrobial in treatment of urethral, endocervical, or rectal GC infections in patients who cannot take cephalosporins or fluoroquinolones.

Can be administered to pregnant women who are allergic to cephalosporins.

Ciprofloxacin (Cipro)

Bactericidal antibiotic that inhibits bacterial DNA synthesis and consequently growth by inhibiting DNA-gyrase in susceptible organisms.

Duration of treatment depends upon severity of infection. Continue treatment for at least 2 d after signs and symptoms of infection have disappeared. Usual treatment duration is 7-14 d.

Ampicillin and sulbactam (Unasyn)

Drug combination that uses beta-lactamase inhibitor with ampicillin; covers skin, enteric flora, and anaerobes.

Used for treatment of nongonococcal infectious tenosynovitis.

Coverage includes Staphylococcus species, Streptococcus species, and anaerobes.

Cefazolin (Ancef)

First-generation semisynthetic cephalosporin, which by binding to 1 or more of the penicillin-binding proteins arrests bacterial cell wall synthesis and inhibits bacterial growth; primarily active against skin flora, including S aureus. Typically, used alone for skin and skin-structure coverage.

Total daily dosages are the same for IV and IM administrations.

Used for suspected staphylococcal and/or streptococcal tenosynovitis (anaerobes not suspected).

Class Summary

These agents have both anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties. Glucocorticoids have profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Dexamethasone acetate (Decadron, AK-Dex, Alba-Dex, Dexone)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Dosage varies with degree of inflammation and size of affected area.

Methylprednisolone acetate (Solu-Medrol, Depo-Medrol, Medrol)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Use 0.5-1 mL (40 mg/mL) mixed with equal or double volume of 1% local anesthetic (ie, lidocaine).

Dosage varies with degree of inflammation and size of affected area.

Hydrocortisone acetate (Solu-Cortef, Cortef)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Use 0.5-1 mL (25 or 50 mg/mL) mixed with equal or double volume of 1% local anesthetic (ie, lidocaine).

Dosage varies with degree of inflammation and size of affected area.