{ "schema_version": 1, "kind": "condition", "id": "bursitis", "name": "Bursitis (prepatellar / olecranon / subacromial)", "category": "chronic", "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)", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 329, "generic": "Naproxen", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "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", "adult_duration": null, "dose_source": "Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ORGOPROXEN 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANOPHARMA > ORGANO", "price_egp": 16.0, "pack_count": 20, "unit_price": 0.8, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPROSYN 500 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > F.HOFFMAN LA ROCHE", "price_egp": 8.05, "pack_count": 10, "unit_price": 0.81, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPROFEN 500MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPROFEN 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "bursitis" }, { "id": 330, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "bursitis" }, { "id": 332, "generic": "Paracetamol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g 3 or 4 times daily (maximum 4 g daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain)", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "bursitis" }, { "id": 331, "generic": "Triamcinolone", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "Smaller joints: 2.5-15 mg; larger joints up to 40 mg", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Endocrine", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Indicated for intra-articular/intrabursal use in adults and children over 6 years.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "PHARCOCINOLONE 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM > PHARCO B", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMCINOL 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC", "price_egp": 11.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPIRELEFAN 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 38.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SYNTHECORTIN 40MG/ML I.M AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 54.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "bursitis" } ] }