From the Guidelines
For dysuria, the most effective treatment approach is to use antibiotics as prescribed by a healthcare provider, along with over-the-counter pain relievers like ibuprofen (200-400mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) to reduce discomfort, as recommended by recent guidelines 1.
Treatment Approach
The treatment for dysuria, which is often a symptom of a urinary tract infection (UTI), involves a combination of pain management and, if necessary, antibiotics. According to the European Association of Urology guidelines on urological infections, for complicated UTIs, a combination of antibiotics such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside can be used 1.
Pain Management
For immediate relief from dysuria, over-the-counter medications such as phenazopyridine (Azo, Pyridium) can be used, with a typical dose of 100-200mg three times daily for 2 days. It's also crucial to increase fluid intake to dilute urine and reduce irritation, aiming for 2-3 liters of water daily. Avoiding potential irritants like caffeine, alcohol, spicy foods, and acidic beverages while symptoms persist is also recommended.
Antibiotic Treatment
If the dysuria is due to a UTI, antibiotic treatment is necessary. The choice of antibiotic should be based on the local antibiogram and resistance patterns. First-line therapies include nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), and fosfomycin, as suggested by the AUA/CUA/SUFU guideline for recurrent uncomplicated urinary tract infections in women 1.
Monitoring and Follow-Up
Symptoms that warrant immediate medical attention include fever, blood in urine, back pain, or symptoms lasting longer than 2-3 days. It's essential to seek medical care if symptoms don't improve quickly or worsen, as untreated urinary infections can spread to the kidneys. Phenazopyridine works by numbing the urinary tract lining but will turn urine orange-red, which is harmless but can stain clothing.
Key Considerations
- Increase fluid intake to help flush out bacteria.
- Avoid irritants that can exacerbate symptoms.
- Seek medical attention for severe or persistent symptoms.
- Follow the prescribed antibiotic regimen if UTI is diagnosed.
- Consider the potential for resistance and the local antibiogram when selecting antibiotics, as highlighted in the European Urology guidelines 1.
From the Research
Treatment Options for Dysuria
- The most common cause of acute dysuria is infection, especially cystitis, and treatment options include antibiotics such as nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole 2, 3, 4.
- Phenazopyridine is also an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis, and can be recommended in addition to etiological therapy 5, 6.
- The combination of fosfomycin and phenazopyridine has been shown to be more effective than the combination of fosfomycin and drotaverine in treating acute uncomplicated cystitis 6.
Antibiotic Treatment
- Nitrofurantoin is a wide-spectrum antibiotic that is commonly used to treat urinary tract infections, and has been shown to be effective against drug-resistant uropathogens 3, 4.
- Fosfomycin is also a effective antibiotic for treating urinary tract infections, and has been shown to have a high clinical and microbiological cure rate when combined with phenazopyridine 6.
- Trimethoprim-sulfamethoxazole is another antibiotic that can be used to treat urinary tract infections, but its use should be guided by resistance levels 4.