Olecranon Bursitis Medication

Updated: Oct 04, 2018
  • Author: J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR; Chief Editor: Stephen Kishner, MD, MHA  more...
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Medication

Medication Summary

Medications are used in cases of olecranon bursitis primarily to decrease pain and inflammation. Thus, the most commonly used medications are oral NSAIDs and focal corticosteroid injection, in conjunction with the rest of the rehabilitation plan. [10]

As previously stated, however, oral NSAIDs probably should be avoided if joint aspiration reveals a hemorrhagic bursitis. Injectable corticosteroid can be beneficial in cases in which the history, physical examination, and joint aspiration do not raise a significant suspicion for infection.

Empiric antibiotic selection is based on the suspected source of the microorganisms (local invasion by skin flora via puncture or abrasion, or hematogenous spread from a primary infection at another body site). Initial antibiotic selection is also directed by the results of the Gram stain of the aspirate.

Antibiotic treatment may start with a broad-spectrum antibiotic; then, when the culture and sensitivity test results are available, the antibiotic regimen may be modified as appropriate.

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs can help to decrease pain and inflammation. Various oral NSAIDs can be used. The choice of an agent is largely based on its adverse-effect profile, as well as on convenience (how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects), patient preferences, and cost.

Although increased treatment cost can be a negative factor, the incidence of costly and potentially fatal gastrointestinal (GI) bleeds is clearly less with cyclo-oxygenase-2 (COX-2) inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance in cases of GI bleeds will further define the populations that will find COX-2 inhibitors to be the most beneficial.

Ibuprofen (Motrin, Advil, Addaprin, Caldolor)

Ibuprofen is the drug of choice for mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Many doses are available, either with or without a prescription.

Celecoxib (Celebrex)

Celecoxib inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, the COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient.

Naproxen (Anaprox, Naprelan, Naprosyn)

Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase (COX), which is responsible for prostaglandin synthesis.

Ketoprofen

Ketoprofen is used for the relief of mild to moderate pain and inflammation. Small doses are indicated initially in patients with small body size, elderly patients, and persons with renal or liver disease. Doses of over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.

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Corticosteroids

Class Summary

In contrast to the widespread, systemic distribution of an oral anti-inflammatory drug, a local corticosteroid injection can achieve focal placement of a potent anti-inflammatory agent at the site of maximal tenderness or inflammation. A variety of corticosteroid preparations are available for injection. Commonly, the corticosteroid is mixed with a local anesthetic agent prior to injection. Various local anesthetic agents also are available.

Methylprednisolone (Depo-Medrol, Solu-Medrol, Medrol, A-Methapred)

Corticosteroids, such as methylprednisolone, are commonly used for local injections of bursae or joints to provide a local anti-inflammatory effect while minimizing some of the GI and other risks of systemic medications.

Methylprednisolone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Dexamethasone (Baycadron)

Dexamethasone may reduce steroid hormone production. It decreases immune reactions. Dexamethasone provides a local anti-inflammatory effect while minimizing some of the gastrointestinal and other risks associated with systemic medications.

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