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Three Part Question

In [adults with traumatic olecranon bursitis]
Should [antibiotics be prescribed]
To [reduce swelling and pain]

Clinical Scenario

A 50 year male presents several hours after a clear history of banging his elbow against a wall. He has the obvious features of an acute olecranon bursitis, there is no undue heat or redness and there are no breaks in the skin to suggest that the bursa is infected. He is afebrile. You are thinking of prescribing NSAIDs and analgesia, but a colleague mentions that antibiotics should also be prescribed for this condition even if sepsis is not suspected clinically. You decide to investigate if there is evidence for this course of action.

Search Strategy

MEDLINE 1950-09/08, CINAHL 1982 –09/08, AMED 1985-09/08, via the OVID interface and EMBASE 1980-09/08. also the Cochrane database.
Medline, CINAHL, EMBASE, AMED, the Cochrane database: [{(exp bursitis OR olecranon bursitis.mp) AND (exp anti-bacterial agents OR antibiotics.mp)}] LIMIT to human AND English language

Search Outcome

5 papers were retrieved from the search, none of which answered the 3 part question. There was one blinded placebo controlled PRCT comparing steroid injection to the olecranon bursa and oral NSAIDs, but not antibiotics.

Comment(s)

Trauma is considered to cause both septic & non-septic olecranon bursitis. Some authors recommend aspiration in all cases (septic & non-septic). The general principles of treatment for olecranon bursitis seem to be rest, local protection, NSAIDs and (if appropriate) antibiotics.

Clinical Bottom Line

Despite the above comments, there is no definitive evidence or study to recommend the use of antibiotics in olecranon bursitis when there is no clinical suspicion of sepsis.