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Septic bursitis

- Absence of pain with joint movement may help differentiate septic bursitis from septic arthritis.

Recommend:

Blood cultures if systemically ill
Baseline and follow-up x-rays to rule out bone or joint involvement
Aspirate fluid initially for drainage and C&S, and aspirate daily until fluid sterile and no longer accumulating.

Usual Pathogens

S. aureus/MRSA
Group A Streptococci

Mild

Empiric Therapy	Dose	Duration
Cephalexin	100mg/kg/d PO div qid	10 days or until 5 days after sterilization of bursa
or
Cloxacillin	100mg/kg/d PO div qid	10 days or until 5 days after sterilization of bursa

MRSA suspected

Empiric Therapy	Dose	Duration
TMP/SMX (if > 1 month old)	8-12mg TMP/kg/d PO div q12h	10 days or until 5 days after sterilization of bursa
+
[Cephalexin	100mg/kg/d PO div qid
or
Cloxacillin]	100mg/kg/d PO div qid

Moderate-severe

Empiric Therapy	Dose	Duration
Cefazolin	100mg/kg/d IV div q8h	10 days or until 5 days after sterilization of bursa
or
Cloxacillin	150-200mg/kg/d IV div q6h	10 days or until 5 days after sterilization of bursa

ß-lactam allergy/MRSA suspected

Empiric Therapy	Dose	Duration
Vancomycin	60mg/kg/d IV div q6h	10 days or until 5 days after sterilization of bursa