What medication can be given to a male patient with a urinary tract infection (UTI) to reduce the burning sensation during urination?

Management of Burning Urination in Male UTI Patients

Phenazopyridine is the recommended medication for relieving the burning sensation during urination in male patients with UTIs, as it provides targeted symptomatic relief while antibiotic therapy addresses the underlying infection. 1

First-line Treatment Approach

• Phenazopyridine 200mg orally three times daily provides symptomatic relief of pain, burning, urgency, and frequency caused by lower urinary tract irritation 1
• Treatment with phenazopyridine should not exceed 2 days, as there is no evidence that combined administration with antibiotics provides greater benefit than antibiotics alone after this period 1
• Phenazopyridine acts directly on the bladder mucosa to provide a local analgesic effect, significantly reducing pain during urination 2, 3

Antibiotic Therapy for the Underlying UTI

• UTIs in males are classified as complicated UTIs according to European Association of Urology guidelines 4
• For empirical treatment of the underlying infection, recommended options include:
  • Amoxicillin plus an aminoglycoside 4
  • A second-generation cephalosporin plus an aminoglycoside 4
  • An intravenous third-generation cephalosporin 4
• Treatment duration for male UTIs should be 14 days when prostatitis cannot be excluded 4

Clinical Evidence for Phenazopyridine

• A randomized, placebo-controlled study demonstrated that phenazopyridine significantly reduced pain during urination (57.4% reduction vs. 35.9% with placebo) and general discomfort (53.4% reduction vs. 28.8% with placebo) within 6 hours of administration 3
• The time to complete resolution of symptoms was significantly shorter in patients receiving phenazopyridine compared to placebo 3
• No serious adverse events were reported with phenazopyridine use 3

Important Considerations

• Phenazopyridine provides only symptomatic relief and should not delay definitive diagnosis and treatment of the underlying UTI 1
• Urine culture and susceptibility testing should be performed before starting antibiotics to guide therapy, as males with UTIs have a higher risk of antimicrobial resistance 4, 5
• Fluoroquinolones (e.g., ciprofloxacin) should not be used for empirical treatment if local resistance rates exceed 10% or if the patient has used fluoroquinolones in the past 6 months 4, 5
• Consider potential underlying urological abnormalities or complicating factors that may require additional management 4

Potential Side Effects and Precautions

• Phenazopyridine causes reddish-orange discoloration of urine, which patients should be informed about to prevent unnecessary concern 1
• The medication may stain clothing and contact lenses 1
• Patients should be advised to take phenazopyridine with food to minimize stomach upset 1