›Compression and elevation
›NSAID options
›Ibuprofen PO 400 mg to 600 mg every 6 hours as needed
›Naproxen PO 250 mg to 500 mg every 12 hours as needed
›Topical diclofenac per product labeling
›Acetaminophen option
›Acetaminophen PO 500 mg to 1000 mg every 6 hours as needed
›Maximum daily dose per local protocol and liver risk
›Aspiration considerations
›Large tense bursa with functional limitation
›Diagnostic uncertainty for infection or crystals
›Hemorrhagic bursa suspicion
›Post aspiration compression wrap
›Reduced recurrence
›Corticosteroid injection considerations
›Persistent aseptic bursitis after conservative therapy
›Avoid if any infection concern
›Avoid repeated injections due to skin atrophy risk
Suspected or confirmed septic bursitis
›Antibiotic strategy
›Empiric coverage targets
›Staphylococcus aureus
›Streptococcus pyogenes
›Oral regimen for mild illness and reliable follow-up
›Cephalexin PO 500 mg every 6 hours
›Typical duration 7 to 14 days
›Dicloxacillin PO 500 mg every 6 hours
›Typical duration 7 to 14 days
›If MRSA risk or beta lactam allergy
›Trimethoprim sulfamethoxazole DS PO 1 tablet every 12 hours
›Combine with beta lactam if streptococcal coverage needed
›Doxycycline PO 100 mg every 12 hours
›Combine with beta lactam if streptococcal coverage needed
›Clindamycin PO 300 mg to 450 mg every 6 to 8 hours
›IV regimen for systemic illness or unreliable follow-up
›Vancomycin IV per weight based dosing and renal function
›Trough and AUC monitoring per local protocol
›Alternative IV options per local antibiogram and allergy profile
›Drainage strategy
›Aspiration for culture and decompression when feasible
›Recurrent fluid reaccumulation
›Repeat aspiration
›Failure of antibiotics or loculated infection
›Surgical drainage consideration
›Bursectomy consideration
Evidence and guideline notes
›Evidence notes
›Empiric antibiotics for septic superficial bursitis covering Staphylococcus aureus and Streptococcus pyogenes
›ACEP Level B recommendation for short-acting opioids as an option for short-term relief of acute musculoskeletal pain when appropriate
›ACEP policy statement supports NSAID and acetaminophen as initial options for acute pain management