From the Guidelines
Dysuria treatment should prioritize nitrofurantoin (Macrobid) 100mg twice daily for 5 days as the first-line option, considering its low resistance rate and effectiveness in treating acute uncomplicated cystitis, as recommended by the most recent guidelines 1.
Treatment Options
The treatment of dysuria, or painful urination, depends on its underlying cause, with bacterial urinary tract infections (UTIs) being the most common cause. The primary treatment for bacterial UTIs is antibiotics.
- First-line options include:
- Nitrofurantoin (Macrobid) 100mg twice daily for 5 days
- Trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days
- Fosfomycin (Monurol) 3g single dose
- While waiting for antibiotics to work, phenazopyridine (Pyridium) 200mg three times daily for 2 days can provide symptom relief by numbing the urinary tract.
Prevention and Recurrence
Increasing fluid intake to 2-3 liters daily helps flush bacteria from the system. Simple measures like avoiding irritants (soaps, bubble baths), wearing cotton underwear, and proper wiping technique (front to back) can prevent recurrence.
- For non-infectious causes like atrophic vaginitis, topical estrogen cream may be prescribed.
- Sexually transmitted infections require specific antibiotics based on the pathogen identified.
Considerations
Prompt treatment is important as untreated urinary infections can ascend to the kidneys, causing more serious infection. If symptoms persist after treatment or recur frequently, further evaluation with urine culture or urological examination may be necessary, as recommended by recent guidelines 1. The choice of antibiotic should consider patient allergy and compliance history, local practice patterns, local community resistance prevalence, availability, cost, and patient and provider threshold for failure, as outlined in previous guidelines 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination
Dysuria treatment with trimethoprim-sulfamethoxazole (PO) may be appropriate for urinary tract infections caused by susceptible bacteria, such as:
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Morganella morganii
- Proteus mirabilis
- Proteus vulgaris It is recommended to use a single effective antibacterial agent for initial episodes of uncomplicated urinary tract infections 2.
From the Research
Dysuria Treatment
- Dysuria, a feeling of pain or discomfort during urination, can be caused by various factors including urinary tract infections, sexually transmitted infections, and noninfectious causes 3, 4, 5.
- The treatment of dysuria depends on the underlying cause, and a comprehensive history and physical examination can often reveal the cause of dysuria 4, 5.
- For urinary tract infections, antimicrobials such as sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid can be effective 6.
- However, the increasing resistance to antibiotics has limited the treatment options for urinary tract infections, and the choice of antibiotic should be guided by local susceptibility patterns and the patient's medical history 7.
- For uncomplicated lower urinary tract infections, a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam can be recommended as first-line empiric antibiotic therapy 7.
- For more complicated cases, such as those involving extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales, other treatment options including oral cephalosporins, fluoroquinolones, and β-lactams may be considered 7.
Diagnostic Evaluation
- A urinalysis should be performed in most patients presenting with dysuria to determine the presence of infection and confirm a suspected diagnosis 3, 4, 5.
- Urine culture should be performed to guide appropriate antibiotic use, especially for recurrent or suspected complicated urinary tract infection 3, 4, 5.
- Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis, and evaluation and treatment of dysuria through a virtual encounter without laboratory testing may increase recurrent symptoms and antibiotic courses 3.
Noninfectious Causes
- Dysuria can also be caused by noninfectious inflammation or trauma, neoplasm, calculi, hypoestrogenism, interstitial cystitis, or psychogenic disorders 4, 5.
- Noninflammatory causes of dysuria include medication use, urethral anatomic abnormalities, local trauma, and interstitial cystitis/bladder pain syndrome 5.
- A comprehensive history and physical examination can often reveal the cause of dysuria, and further diagnostic evaluation may be necessary to determine the underlying cause 4, 5.