What is the treatment for urinary tract infections (UTIs) implied by AZO (Phenazopyridine)?

From the Guidelines

AZO (phenazopyridine) is not a treatment for urinary tract infections, but rather a medication that helps relieve the painful symptoms associated with UTIs, and should be used alongside appropriate antibiotic therapy, such as nitrofurantoin or trimethoprim-sulfamethoxazole, as recommended by the American College of Physicians 1. The treatment of urinary tract infections (UTIs) typically involves antibiotics, with the choice of antibiotic depending on the severity and type of infection. For uncomplicated cystitis, the American College of Physicians recommends short-course antibiotics, such as nitrofurantoin for 5 days or trimethoprim-sulfamethoxazole for 3 days 1. Some key points to consider when treating UTIs include:

• The use of phenazopyridine to relieve symptoms, but not to treat the underlying infection
• The importance of choosing an antibiotic that is effective against the bacteria causing the infection
• The need to use antibiotics for the recommended duration to ensure complete treatment of the infection
• The potential for side effects, such as stomach upset, and the importance of drinking plenty of water while taking antibiotics. It's also important to note that the treatment of UTIs should be guided by the most recent and highest quality evidence, such as the 2021 study published in the Annals of Internal Medicine 1, which provides best practice advice for the treatment of UTIs. In terms of specific antibiotics, the study recommends:
• Nitrofurantoin for 5 days for uncomplicated cystitis
• Trimethoprim-sulfamethoxazole for 3 days for uncomplicated cystitis
• Fosfomycin as a single dose for uncomplicated cystitis
• Fluoroquinolones for 5-7 days for uncomplicated pyelonephritis
• Trimethoprim-sulfamethoxazole for 14 days for uncomplicated pyelonephritis.

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 use of Phenazopyridine HCl for relief of symptoms should not delay definitive diagnosis and treatment of causative conditions. Treatment of a urinary tract infection with Phenazopyridine HCl should not exceed 2 days because there is a lack of evidence that the combined administration of Phenazopyridine HCl and an antibacterial provides greater benefit than administration of the antibacterial alone after 2 days.

The treatment for urinary tract infections (UTIs) implied by AZO (Phenazopyridine) is symptomatic relief of pain, burning, urgency, frequency, and other discomforts, and should be used in conjunction with antibacterial therapy. The use of Phenazopyridine HCl should not exceed 2 days. It is essential to institute prompt appropriate treatment of the cause of pain and discontinue Phenazopyridine HCl when symptoms are controlled 2.

• Key points:
  • Symptomatic relief of UTI symptoms
  • Use in conjunction with antibacterial therapy
  • Limited to 2 days of treatment
  • Prompt treatment of the underlying cause is necessary

From the Research

Treatment for Urinary Tract Infections (UTIs) Implied by AZO (Phenazopyridine)

• AZO (Phenazopyridine) is a urinary analgesic that helps relieve pain, burning, and discomfort associated with UTIs, but it does not treat the infection itself 3, 4.
• The treatment for UTIs typically involves antibiotics, with the choice of antibiotic depending on the severity of the infection, the type of bacteria causing the infection, and the patient's medical history 3, 4, 5.
• First-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females includes a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 3.
• Other treatment options for UTIs include oral cephalosporins, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate 3, 4.
• Nitrofurantoin is a commonly used antibiotic for treating uncomplicated UTIs and has been shown to be effective and cost-minimizing compared to other antibiotics 6, 7.
• The clinical efficacy of nitrofurantoin for treating uncomplicated UTIs in adults has been demonstrated in several randomized control trials, with clinical cure rates ranging from 51 to 94% and bacteriological cure rates ranging from 61 to 92% 7.