What medication is used to treat burning during urination (dysuria)?

Treatment for Burning During Urination (Dysuria)

For symptomatic relief of burning during urination, phenazopyridine (Pyridium) 200 mg three times daily for up to 2 days provides rapid topical analgesia while definitive antibiotic therapy addresses the underlying infection. 1

Immediate Symptomatic Management

• Phenazopyridine is the medication specifically indicated for symptomatic relief of pain, burning, urgency, and frequency arising from lower urinary tract irritation. 1
• The drug exerts a topical analgesic effect directly on the urinary tract mucosa, providing rapid relief within hours. 1
• Maximum duration is 2 days because there is no evidence that combined administration with antibiotics provides greater benefit beyond this timeframe. 1
• The analgesic action may reduce or eliminate the need for systemic analgesics or narcotics and is compatible with concurrent antibacterial therapy. 1

Definitive Antibiotic Treatment

Symptomatic treatment alone is insufficient—prompt appropriate antibiotic therapy must be instituted simultaneously to treat the causative infection. 1

For Women with Uncomplicated Cystitis:

• First-line options include nitrofurantoin (5-day course), fosfomycin 3g single dose, or pivmecillinam 400 mg three times daily for 3-5 days. 2, 3
• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days is an alternative if local resistance is <20%. 2

For Men with UTI (Always Considered Complicated):

• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7-14 days is the first-line treatment. 4
• Men require minimum 7 days of treatment due to potential prostatic involvement—never use the 3-day regimens studied in women. 4, 2
• Fluoroquinolones (ciprofloxacin 500 mg twice daily or levofloxacin 750 mg once daily for 7-14 days) are alternatives when trimethoprim-sulfamethoxazole cannot be used. 4
• If the patient becomes afebrile within 48 hours with clear clinical improvement, 7 days is acceptable; if prostatitis cannot be excluded, treat for 14 days. 4

For Urethritis (Gonococcal or Nongonococcal):

• If diagnostic tools are unavailable, treat empirically for both N. gonorrhoeae and C. trachomatis. 5
• Nongonococcal urethritis is most frequently caused by C. trachomatis (23-55% of cases) or U. urealyticum (20-40% of cases). 5

Critical Clinical Considerations

• Obtain urine culture before initiating antibiotics in all men, as this is crucial to guide potential adjustments based on susceptibility results. 4
• Common uropathogens include E. coli, Proteus species, Klebsiella species, Pseudomonas species, and Enterococcus species. 4
• Phenazopyridine should be discontinued when symptoms are controlled—it provides only symptomatic relief and should not delay definitive diagnosis. 1

Common Pitfalls to Avoid

• Do not use phenazopyridine for more than 2 days—there is no evidence of additional benefit and it may mask treatment failure. 1
• Do not treat men with 3-5 day antibiotic courses—this is inadequate and risks treatment failure. 4, 2
• Do not use amoxicillin or ampicillin empirically for UTIs due to high worldwide resistance rates and poor efficacy. 2
• Do not skip urine culture in men—this complicates management if initial empiric therapy fails and susceptibility data is lacking. 4
• Fluoroquinolones should not be used as first-line empiric therapy when other effective options like trimethoprim-sulfamethoxazole are available. 4