What medication is used to treat urethral burning associated with a urinary tract infection (UTI)?

Treatment of Urethral Burning in Urinary Tract Infections

Phenazopyridine is the medication of choice for symptomatic relief of urethral burning associated with UTIs, while appropriate antibiotics should be used to treat the underlying infection. 1

First-line Management

Symptomatic Relief

• Phenazopyridine HCl: Specifically indicated for relief of pain, burning, urgency, and frequency arising from urinary tract irritation 1
  • Dosing: Typically 200mg three times daily
  • Duration: Should not exceed 2 days while antibiotics treat the underlying infection
  • Mechanism: Provides local analgesic effect on urinary tract mucosa
  • Note: Causes orange/red discoloration of urine (patients should be warned)

Concurrent Antibiotic Treatment

Antibiotics must be prescribed alongside phenazopyridine to treat the underlying infection:

• First-line antibiotics for uncomplicated UTIs:
  • Nitrofurantoin 100mg twice daily for 5 days 2
  • Fosfomycin 3g single dose 2
  • Trimethoprim-sulfamethoxazole 160/800mg twice daily for 3 days (if local resistance <20%) 2

Special Considerations

When to Use Phenazopyridine

• Use when urethral burning/pain is a predominant symptom
• The analgesic action may reduce or eliminate the need for systemic analgesics 1
• Compatible with antibacterial therapy and provides relief during the interval before antibiotics control the infection 1

Important Cautions

• Phenazopyridine is for symptomatic relief only and should not delay definitive diagnosis and treatment 1
• Treatment with phenazopyridine should not exceed 2 days as there is no evidence that combined administration beyond this period provides greater benefit than antibiotics alone 1
• Patients should be informed that improvement in symptoms does not indicate cure of the infection - complete antibiotic course is essential

Alternative Approaches for Symptom Relief

• Increased fluid intake to dilute urine and reduce irritation
• Avoiding bladder irritants (caffeine, alcohol, spicy foods) during acute symptoms
• Warm sitz baths for external urethral discomfort

Treatment Algorithm

1. Confirm UTI diagnosis (based on symptoms and urinalysis)
2. Start phenazopyridine for symptomatic relief of urethral burning
3. Simultaneously start appropriate antibiotic based on patient factors and local resistance patterns
4. Discontinue phenazopyridine after 2 days while completing the full antibiotic course
5. Reassess if symptoms don't resolve within 48-72 hours of treatment 2

Common Pitfalls

• Using phenazopyridine without antibiotics (treats symptoms but not infection)
• Continuing phenazopyridine beyond 2 days (not recommended)
• Mistaking symptom relief for cure (patients may stop antibiotics prematurely)
• Failing to warn patients about urine discoloration (can stain clothing)
• Not considering alternative diagnoses if symptoms persist despite appropriate therapy

Remember that while phenazopyridine effectively relieves the discomfort of urethral burning, appropriate antibiotic therapy is essential to treat the underlying UTI and prevent complications.