Treatment for Dysuria (Painful Urination)
For dysuria treatment, empiric antibiotic therapy should be initiated after obtaining a urine culture, with the choice of antibiotic based on local resistance patterns and patient factors. 1
Diagnosis of Dysuria
- Dysuria (painful urination) is a central symptom of urinary tract infection (UTI) with over 90% accuracy in young women when not accompanied by vaginal symptoms 2
- Associated symptoms may include increased frequency, urgency, hematuria, new or worsening incontinence, and suprapubic pain 2
- Urinalysis should be performed for most patients presenting with dysuria to detect leukocytes, nitrites, and blood 3, 4
- Urine culture should be obtained before starting antibiotics, especially for recurrent or complicated UTIs 1, 4
Treatment Algorithm for Dysuria
Uncomplicated UTI in Women
First-line empiric therapy options 1, 4:
- Nitrofurantoin 100 mg twice daily for 5 days
- Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days (if local resistance <20%)
- Fosfomycin 3 g single dose
Duration of therapy 1:
- 3-5 days for uncomplicated lower UTI in women
- Avoid fluoroquinolones for empirical treatment if used in the last 6 months due to resistance risk
Complicated UTI
- For patients with diabetes, structural abnormalities, or immunosuppression 1, 5:
- Ciprofloxacin 500-750 mg twice daily for 7-14 days (if local resistance <10%)
- Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 14 days
- Treatment duration should be 7-14 days
Catheter-Associated UTI
- Replace or remove the indwelling catheter before starting antimicrobial therapy 1
- Treat according to complicated UTI recommendations 1
- Do not treat asymptomatic bacteriuria in catheterized patients 1
Postmenopausal Women with Recurrent UTIs
- Consider vaginal estrogen therapy with or without lactobacillus-containing probiotics 1
- For prevention, consider methenamine hippurate as a non-antibiotic alternative 1
Premenopausal Women with Post-Coital UTIs
- Consider low-dose antibiotic prophylaxis within 2 hours of sexual activity for 6-12 months 1
Special Considerations
- Adjust antibiotic therapy based on culture results when available 1, 5
- Reassess symptoms after 48-72 hours of treatment 5
- For persistent symptoms despite treatment, repeat urine culture before prescribing additional antibiotics 1
- Non-antibiotic symptomatic treatment with NSAIDs (like ibuprofen) may be considered for uncomplicated UTIs in otherwise healthy women, though antibiotics remain first-line therapy 6
Common Pitfalls to Avoid
- Do not treat asymptomatic bacteriuria in general population 1
- Avoid classifying patients with recurrent UTIs as "complicated" as this often leads to use of broad-spectrum antibiotics with long durations of treatment 1
- Do not use ciprofloxacin if local resistance rates are >10% or if the patient has used fluoroquinolones in the last 6 months 1
- Avoid topical antiseptics or antimicrobials to the catheter, urethra, or meatus 1
- Do not use prophylactic antimicrobials to prevent catheter-associated UTI 1