Bursitis in Emergency Medicine Medication
- Author: Eileen Chang, MD; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Nonsteroidal anti-inflammatory agents
Class Summary
Most commonly used for relief of mild to moderately severe pain. Although pain-relieving effects tend to be patient specific, ibuprofen is usually used for initial therapy.
Ibuprofen (Ibuprin, Advil, Motrin)
DOC for mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Anaprox, Naprelan, Naprosyn)
For relief of mild to moderately severe pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis.
Antibiotics
Class Summary
Therapy must cover all likely pathogens in the context of the clinical setting.
Oxacillin (Bactocill, Prostaphlin)
Bactericidal antibiotic that inhibits cell wall synthesis. Used in the treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.
Dicloxacillin (Dycill, Dynapen)
Binds to one or more penicillin-binding proteins, which, in turn, inhibits synthesis of bacterial cell walls. For treatment of infections caused by penicillinase-producing staphylococci. May use to initiate therapy when staphylococcal infection is suspected.
Resistance to this drug results from alterations in penicillin-binding proteins.
Cephalexin (Keflex, Biocef)
First-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora; used for skin infections or prophylaxis in minor procedures.
Cefazolin (Ancef, Kefzol, Zolicef)
First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin-structure coverage. IV and IM dosing regimens similar.
Vancomycin (Vancocin)
Potent antibiotic directed against gram-positive organisms and active against enterococci. Indicated for patients who cannot receive or have not responded to penicillins and cephalosporins or who have infections with resistant staphylococci.
To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use CrCl to adjust dose in patients diagnosed with renal impairment.
Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing GI or GU procedures.
May need to adjust dose in renal impairment.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, they modify the body's immune response to diverse stimuli.
Hydrocortisone (Solu-Cortef, Westcort)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Methylprednisolone (AK-Pred, Delta-Cortef, Articulose-50, Econopred)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.
Dexamethasone (Decadron, Dexasone)
For various inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.
Anesthetics
Class Summary
These agents are used to induce local analgesia.
Lidocaine 1-2% (Xylocaine)
Local anesthetic used to reduce pain resulting from inflammatory reactions associated with bursitis.
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