From the Guidelines
Dysuria treatment should prioritize the use of first-line antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, with consideration of local antimicrobial susceptibility profiles and patient-specific factors, as recommended by the most recent guidelines 1. When treating dysuria, it is essential to consider the underlying cause, with bacterial urinary tract infections (UTIs) being the most common cause.
- First-line antibiotic options include:
- Nitrofurantoin (Macrobid) 100mg twice daily for 5 days
- Trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days
- Fosfomycin (Monurol) 3g single dose
- While waiting for antibiotics to work, phenazopyridine (Pyridium) 200mg three times daily for 2 days can provide symptom relief by numbing the urinary tract.
- Increasing fluid intake to 2-3 liters daily helps flush bacteria from the system.
- For non-infectious causes like atrophic vaginitis, topical estrogen cream may be prescribed.
- Sexually transmitted infections require specific antibiotics based on the pathogen identified.
- Simple measures like avoiding irritants (soaps, bubble baths), wearing cotton underwear, and proper wiping technique (front to back) can prevent recurrence.
- Prompt treatment is crucial, as untreated urinary infections can ascend to the kidneys, causing more serious infection, and it is recommended to obtain a urine culture before starting antibiotics and to treat people with recurrent UTIs with as short a duration of antibiotics as is reasonable, generally no longer than 7 days 1.
- If symptoms include fever, flank pain, or blood in urine, immediate medical attention is needed, as these suggest kidney involvement.
- Avoid treating asymptomatic bacteriuria, as this can foster antimicrobial resistance and increase the number of recurrent UTI episodes 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination
Dysuria treatment with trimethoprim-sulfamethoxazole (PO) may be appropriate for urinary tract infections caused by susceptible bacteria, such as:
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Morganella morganii
- Proteus mirabilis
- Proteus vulgaris It is recommended to use a single effective antibacterial agent for initial episodes of uncomplicated urinary tract infections 2.
From the Research
Dysuria Treatment
- Dysuria, a feeling of pain or discomfort during urination, can be caused by urinary tract infection, sexually transmitted infection, bladder irritants, skin lesions, and some chronic pain conditions 3.
- The most common cause of acute dysuria is infection, especially cystitis, and other infectious causes include urethritis, sexually transmitted infections, and vaginitis 4.
- Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas 5.
- For women with acute dysuria, a single-dose or 10-day course of trimethoprim-sulfamethoxazole can be effective, but the 10-day course yields a superior cure rate at 2 weeks after the start of treatment 6.
- Sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid are excreted in the urine in high concentration and are active in vitro against usual aerobic gram-negative bacteria, making them useful for treatment of uncomplicated lower urinary tract infections 7.
Treatment Options
- Trimethoprim-sulfamethoxazole is a very effective combination agent in vitro, has appealing pharmacokinetic properties, and is usually well tolerated by patients, but is more expensive than sulfonamides and is ordinarily not indicated for initial treatment 7.
- A sulfonamide is often considered the agent of first choice, with either nitrofurantoin or nalidixic acid as an alternative if sulfonamides cannot be tolerated 7.
- Urine culture should be performed to guide appropriate antibiotic use, especially for recurrent or suspected complicated urinary tract infection 3.
Diagnostic Evaluation
- History is most often useful for finding signs of sexually transmitted infection, complicated infections, lower urinary symptoms in males, and noninfectious causes 3.
- Most patients presenting with dysuria should have a urinalysis performed, and vaginal discharge decreases the likelihood of urinary tract infection 3.
- Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis 3.