From the Guidelines
Antibiotics are the primary treatment for burning urination associated with urinary tract infections (UTIs), with nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin being common first-line options. According to the most recent guidelines, nitrofurantoin (Macrobid) 100mg twice daily for 5 days is a recommended treatment for uncomplicated cystitis 1. Additionally, trimethoprim-sulfamethoxazole (Bactrim) DS tablet twice daily for 3 days and fosfomycin (Monurol) as a single 3-gram dose are also effective options 1. While waiting for antibiotics to work, phenazopyridine (Azo, Pyridium) 100-200mg three times daily can provide temporary relief from burning and pain during urination by numbing the urinary tract lining 1. This medication turns urine orange-red and should be used for no more than 2 days. Drinking plenty of water helps flush bacteria from the system. UTIs occur when bacteria enter and multiply in the urinary tract, with E. coli being the most common cause. If symptoms worsen or don't improve within 48 hours of starting antibiotics, medical attention should be sought as the infection could spread to the kidneys.
Some key considerations when choosing an antibiotic include:
- Local resistance rates
- Patient allergy history
- Tolerance
- Availability
- Cost
- Patient and provider threshold for failure
It's also important to note that fluoroquinolones should be reserved for patients with a history of resistant organisms 1. Furthermore, asymptomatic bacteriuria should not be treated as it can foster antimicrobial resistance and increase the number of recurrent UTI episodes 1.
In terms of prevention, drinking plenty of water can help flush bacteria from the system, and urine culture should be obtained when an acute UTI is suspected to guide antibiotic treatment 1.
Overall, the choice of antibiotic should be individualized based on patient-specific factors and local resistance patterns. Nitrofurantoin is a reasonable drug of choice for uncomplicated cystitis due to its efficacy and ability to spare use of more systemically active agents for treating other infections 1.
From the FDA Drug Label
Phenazopyridine HCl is indicated for the symptomatic relief of pain, burning, urgency, frequency, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, endoscopic procedures, or the passage of sounds or catheters The medication used to treat burning urination associated with urinary tract infections (UTIs) is phenazopyridine.
- It provides symptomatic relief of pain, burning, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection.
- The use of phenazopyridine should not delay definitive diagnosis and treatment of causative conditions, and it should be discontinued when symptoms are controlled 2.
From the Research
Medication for Burning Urination
Burning urination is a common symptom of urinary tract infections (UTIs). The following medications are used to treat burning urination associated with UTIs:
- Antibiotics such as sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid 3
- Nitrofurantoin, fosfomycin tromethamine, and pivmecillinam are recommended as first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 4
- Trimethoprim-sulfamethoxazole, nitrofurantoin monohydrate/macrocrystals, and fosfomycin trometamol are appropriate first-line therapies for uncomplicated cystitis 5
- Phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy 6
Treatment Options
Treatment options for UTIs depend on the severity and type of infection. For uncomplicated UTIs, the following treatment options are available:
- Oral antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin tromethamine 4, 5
- Phenazopyridine for symptomatic relief of burning urination 6
- For complicated UTIs, parenteral antibiotics such as piperacillin-tazobactam, carbapenems, and ceftazidime-avibactam may be necessary 4
Considerations
When choosing a medication for burning urination, the following considerations should be taken into account: