Dawaa Reference

chronic

Bursitis (prepatellar / olecranon / subacromial)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 sources

Egyptian National Drug Formulary - Cardiovascular 2024 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Meloxicam 15 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 101306) · Bursitis - StatPearls - NCBI Bookshelf - disease-level clinical article (bursitis-full.txt) · Williams CH, Jamal Z, Sternard BT. Bursitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Jul 24. Bookshelf ID: NBK513340; PMID: 30020712. · MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain)

Verified against6 documents
  • Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)
  • Meloxicam 15 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 101306)
  • Egyptian National Drug Formulary - Endocrine
  • No dose - referral pathway, no medicine given in primary care
  • Bursitis - StatPearls - NCBI Bookshelf - disease-level clinical article (bursitis-full.txt)
  • MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • The sudden form follows injury, infection or crystal disease, while the long-standing form follows inflammatory arthritis or repeated pressure at work
  • Many report pain when they move the joint themselves, yet the same movement done for them hurts little
  • Ischial bursitis can give shooting pain that is worse on sitting [burning pain]

Signs — what you find (8)

  • Pressing directly over the bursa reproduces the pain in the sudden form
  • The joint moves through a reduced arc, and it is the pain that limits it
  • At the kneecap and the elbow, bending the joint hurts while straightening it does not
  • Long-standing bursitis is frequently painless on examination
  • Given time the sac enlarges to hold the extra fluid, so what you see is a bulky, thickened swelling
  • A rise of 2.2 °C in skin temperature over the affected side, against the opposite side, was both sensitive and specific for a septic bursa in one study [fever · sepsis]
  • A deep bursa can be acutely inflamed and still give neither tenderness on pressing nor any visible skin change
  • At the knee an effusion is not typical, so finding one points away from a bursa

Tests (6)

  • Take a plain radiograph where there has been an injury, or where a retained foreign body or a break in the bone could explain the swelling
  • Deep bursae need MRI or ultrasound; the latter images live and can be watched while the joint is moved
  • A cobblestone pattern in the fat above the bursa on ultrasound separates cellulitis from an infected bursa
  • Colour Doppler shows hyperaemia of the bursa and nearby tissue when it is infected
  • Aspirate the bursa where sepsis or crystal disease is in question, and send the fluid for a cell count, Gram stain with culture, glucose and crystal analysis
  • Fewer than 500 white cells per mm3 in the aspirate fits a bursitis that is neither infected nor crystal driven

If not this — what else fits (9)

  • Osteoarthritis
  • Rheumatoid arthritis and other inflammatory joint disease
  • Rotator cuff or labral tear and shoulder impingement, where the pain is at the shoulder
  • Gout or pseudogout, particularly around the elbow and the knee
  • Sciatica, though ischial bursitis is the one that hurts more on sitting
  • Iliotibial band syndrome, whose tenderness lies further down the thigh than the trochanteric bursa
  • MCL strain or tear, meniscal injury and tibial plateau fracture at the knee
  • Achilles tendinitis, bone spur pain or plantar fasciitis at the heel
  • Septic joint, or plain cellulitis of the skin lying over the bursa

SourceStatPearls "Bursitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Analgesia - non-NSAID first-line option

MAIN TREATMENT - choose one

1

NAPROXEN

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg initially followed by 250 mg at 6-8 hour intervals up to a maximum daily dose after the first day of 1250 mg

Paediatric dose

Not recommended under 16 years for this indication - the product label restricts paediatric naproxen to juvenile idiopathic arthritis (10 mg/kg/day in two divided doses, child over 5 years). Use paracetamol or ibuprofen instead.

Choice

Alternatives. Both are non-selective NSAIDs; naproxen is the cheaper by a wide margin (8-24 EGP against 7-142) and dosed twice daily.

Dose source

Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)

Why

Non-selective NSAID that blocks cyclooxygenase and prostaglandin synthesis, reducing the inflammatory pain and swelling of an aseptic bursitis.

Cautions
  • Rule out septic bursitis (fever, severe erythema, warmth, purulent aspirate) before starting anti-inflammatory monotherapy.
  • Co-prescribe PPI in elderly or ulcer-prone patients.
  • Contraindicated in active or history of recurrent peptic ulcer or GI haemorrhage.
  • Contraindicated in active or history of recurrent peptic ulcer/haemorrhage.
  • Contraindicated in severe hepatic, renal and cardiac failure.
Egyptian brands
Egyptian brandManufacturerIndicative price
ORGOPROXEN 500 MG 20 TAB.ORGANOPHARMA > ORGANO16.00 EGP (0.80/unit)
NAPROSYN 500 MG 10 TAB.MISR > F.HOFFMAN LA ROCHE8.05 EGP (0.81/unit)
NAPROFEN 500MG 10 TAB.EL NILE.12.00 EGP (1.20/unit)
NAPROFEN 500MG 20 TAB.EL NILE.24.00 EGP (1.20/unit)
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

No dose - referral pathway, no medicine given in primary care

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Septic bursitis needs systemic antibiotics (gram-positive coverage) as first-line therapy, not NSAIDs alone.
  • RED FLAG - The admission criteria for septic bursitis are systemic or whole-joint involvement and an unstable patient.
  • RED FLAG - Corticosteroid injection is for deep bursae only. Injecting a superficial one - prepatellar, olecranon - risks seeding infection into the bursa, injuring the tendon under it, thinning the skin above it, and leaving a sinus that will not close.
  • A corticosteroid injection can relieve pain well enough to delay the diagnosis of a rotator cuff tear, which has an optimal window for surgical repair.
  • Evidence for corticosteroid injection in chronic bursitis is weak, and a recent study found no benefit.
  • RED FLAG - Skin over the affected bursa that is 2.2 degrees C warmer than the same bursa on the other side is highly sensitive and specific for septic bursitis.
  • RED FLAG - Aspirate the bursa whenever septic bursitis or crystal disease is in question; an aspirate white cell count under 500/mm3 fits non-infective, non-crystalline bursitis.
  • RED FLAG - A septic bursa can be mistaken for a septic joint or for simple cellulitis; missing an infected joint carries significant morbidity and mortality.
  • RED FLAG - Diabetes, HIV, rheumatological disease and alcohol dependence all raise the risk that a bursitis is septic.
  • RED FLAG - In subacromial bursitis, do not immobilise the shoulder - immobilisation can cause atrophy, retraction and a frozen shoulder.
  • When bursitis is driven by a systemic inflammatory disease, treat the underlying condition rather than the bursa alone.
3

TRIAMCINOLONE

2nd line

Forminjection

Adult dose and duration

Smaller joints: 2.5-15 mg; larger joints up to 40 mg

Paediatric dose

Indicated for intra-articular/intrabursal use in adults and children over 6 years.

Dose source

Egyptian National Drug Formulary - Endocrine

Why

Intrabursal corticosteroid injection for symptomatic relief of a deep bursitis, such as subacromial. The source restricts the injection to the deeper bursa and advises against the superficial prepatellar and olecranon bursae.

Cautions
  • DEEP BURSAE ONLY, such as the subacromial bursa. Do not inject a corticosteroid into a superficial bursa - prepatellar or olecranon. Doing so raises the risk of septic bursitis introduced by the needle, of damage to the tendon beneath, of skin thinning over it, and of sinus tracts that go on draining.
  • Hypersensitivity to Triamcinolone or any component of the formulation.
  • The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy.
Egyptian brands
Egyptian brandManufacturerIndicative price
PHARCOCINOLONE 40MG/ML I.M AMP.CHEMIPHARM > PHARCO B8.00 EGP
AMCINOL 40MG/ML I.M AMP.SIGMA TEC11.00 EGP
EPIRELEFAN 40MG/ML I.M AMP.EIPICO38.00 EGP
SYNTHECORTIN 40MG/ML I.M AMP.MUP54.00 EGP

ANALGESIA - NON-NSAID FIRST-LINE OPTION

4

PARACETAMOL

Analgesia - non-NSAID first-line option

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g 3 or 4 times daily (maximum 4 g daily)

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(MSF: child 1 month and over, 15 mg/kg 3 or 4 times daily (maximum 60 mg/kg daily); child under 1 month, 10 mg/kg 3 or 4 times daily (maximum 40 mg/kg daily).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain)

Why

The disease article names NSAIDs and paracetamol together as the first-line analgesics for bursitis; the card offered only naproxen, so a patient in whom an NSAID is unsuitable - peptic ulcer, renal impairment, anticoagulation - had no analgesic option at all. MSF Essential Drugs gives paracetamol an explicit mild-pain indication with an adult and a paediatric dose.

Cautions
  • Do not exceed indicated doses, especially in children and older patients. Paracetamol intoxications are severe (hepatic cytolysis).
  • Administer with caution to patients with hepatic impairment.
  • Paracetamol has no anti-inflammatory properties.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.