- What Is a Urinary Tract Infection?
- Etiology and Risk Factors
- Clinical Presentation and Diagnosis
- Preventive Measures
- Management: Nonprescription Products
- Role of the Pharmacist
- What Causes UTIs?
- How Can I Tell if I Have a UTI?
- What Can I Take to Relieve Pain?
- What Natural Supplements Can I Take to Prevent Another UTI?
- What Steps Can I Take to Prevent Another UTI?
- What is Azo-Standard?
- How should I take Azo-Standard?
- What should I avoid while taking Azo-Standard?
- More about Azo-Standard (phenazopyridine)
- AZO Yeast Infection Symptom Treatment Tablets60.0ea
- Azo-Standard (phenazopyridine) Drug Interactions
- Check for interactions
- Most frequently checked interactions
- Treating Yeast Infections and Drug Interactions
What Is a Urinary Tract Infection?
US Pharm. 2017;9(42):4-7.
Urinary tract infections (UTIs) are the most commonly occurring infections, affecting approximately 150 million people worldwide each year.1 In the United States alone, the societal costs of UTIs are estimated to be $3.5 billion annually.1 UTIs can affect both men and women, but they are especially common in women of childbearing age.2 Most women will experience at least one episode during their lifetime; by 32 years of age, more than half of all women will have reported having at least one urinary tract infection.2,3 Almost 25% of women will have a recurrent infection within a year.2
A UTI is an infection of the urinary system. UTIs are classified as uncomplicated and complicated.4 Uncomplicated UTIs are those occurring in healthy, premenopausal women with no urinary tract abnormalities.3 Complicated UTIs are caused by abnormalities that compromise the urinary tract, such as urinary obstruction, urinary retention, immunosuppression, renal failure, renal transplantation, and presence of foreign objects; pregnancy is another cause.1 Indwelling catheters account for one million cases, or 70% to 80%, of complicated UTIs in the U.S. per year.1 Complicated UTIs occur in both sexes and often affect the upper and lower urinary tracts. UTIs are further categorized based on location: lower UTIs (cystitis) and upper UTIs (pyelonephritis). Pharmacists will frequently encounter patients inquiring about relief from UTI-related symptoms, so it is important that they understand the various OTC products marketed for the management of UTIs.
Etiology and Risk Factors
Urine is generally sterile, and the causative agents for most UTIs originate in bowel flora that enter the periurethral area. Most UTIs are caused by one organism; UTIs caused by multiple organisms may indicate contamination. The causative agents are gram-positive and gram-negative organisms, as well as some fungi.1 The gram-negative bacterium Escherichia coli accounts for almost 90% of all episodes.3,5 Other common causative agents include Staphylococcus saprophyticus, Klebsiella pneumoniae, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida species.
Women are more likely to develop a UTI because their urethras are shorter than men’s.5 Other risk factors include previous episodes of UTI, sexual intercourse, spermicide use, new sexual partner, reduced mobility, changes in vaginal flora, pregnancy, menopause, diabetes, urinary incontinence, kidney stones, prostate enlargement, and history of UTI in a first-degree relative.2,4,5 In the elderly population, other risk factors to consider are age-related changes in immune function, increased exposure to nosocomial pathogens, and an increased number of comorbidities.6 Certain behaviors are thought to contribute to the development of UTIs, such as frequency of urination and delayed voiding, not voiding pre- and postcoitally, consumption of certain beverages, hot tub usage, douching, wiping patterns, and choice of clothing; BMI may also be a factor. A case-control study found no increased risk of UTI development with these practices.7
Clinical Presentation and Diagnosis
Patients with cystitis often present with a frequent, persistent urge to urinate despite passing a small amount, dysuria or a burning sensation during urination, or suprapubic heaviness.7 Patients with pyelonephritis often experience flank pain or tenderness, a low fever (<101 F), chills, nausea, vomiting, and malaise with or without symptoms of cystitis.2 Patients with a lower or upper UTI may experience hematuria or notice that their urine is cloudy or has a strong odor. Elderly patients tend to present with nonspecific symptoms including altered mental status, change in eating habits, lower abdominal pain, and gastrointestinal symptoms such as constipation.6
In most patients who present with signs and symptoms of UTIs, a history of illness is the most important diagnostic tool, especially when symptom onset is sudden or severe and when vaginal discharge and irritation are not present.2,3 Sometimes, however, UTI diagnosis cannot rely solely on patient symptoms because some patients are asymptomatic; this is more common in older adults than in younger adults.6 Laboratory tests, urine-sample tests, and pelvic examinations should be performed in patients with urinary tract symptoms to properly diagnose UTIs.2,3 Laboratory tests for UTIs include assessments for the presence of bacteriuria and pyuria, nitrite, leukocyte esterase, and antibody-coated bacteria.2
Commercially available dipsticks may be used to detect the presence of a UTI. The pharmacist can recommend an OTC UTI home test kit to determine whether causative agents of UTI are present. After use, the patient should call the physician with the results for evaluation and treatment. The available test kits detect leukocyte esterase and nitrite. Testing for these substances increases overall sensitivity and specificity and reduces the risk of false-negative results.8 Self-testing for UTIs has been proven accurate with proper use, but to avoid inaccurate or false results, patients should be advised to obtain a clean-catch urine specimen and to avoid consuming more than 250 mg of vitamin C within 24 hours of testing; women should not test during their menses.8,9 A strict vegetarian diet, tetracycline, and phenazopyridine may cause inaccurate results.9
Almost 25% of women experience recurrent episodes of UTI.10 This is defined as either two uncomplicated UTIs in 6 months or three or more positive cultures within the preceding 12 months.10 UTIs can occur even when precautions are taken, but pharmacists can recommend preventive measures to reduce a patient’s risk for recurrent infections. If a woman is using spermicide-containing contraceptives, she should be counseled about the possible connection between her contraceptive method and recurrent infections, and an alternative form of contraception should be considered. Although studies have not indicated a correlation, behavioral modifications such as staying hydrated, urinating before and after sexual activity, urinating regularly, using tampons instead of sanitary pads and changing them every 3 hours, wiping from front to back, wearing clean cotton underwear and loose-fitting, breathable clothing, and taking showers instead of baths may be helpful. Topical estrogen therapy in postmenopausal women may help prevent UTI recurrences by altering the vaginal flora.6,11 Evidence for use of acupuncture and immunoprophylactic regimens is limited.12
There is little evidence of the efficacy of natural supplements in the prevention of UTIs. Research suggests that the antioxidant proanthocyanidin and the fructose in cranberries can help prevent bacteria, particularly E coli, from clinging to the walls of the urinary tract.13 Cranberry products are available in an array of dosage forms: juice, syrup, capsules, and tablets. Data on the efficacy of cranberry juice in preventing recurrent UTIs are conflicting. A recent Cochrane review determined that cranberry products do not significantly reduce the risk of recurrences compared with placebo.13 Similarly, the use of probiotics has also been considered for the prevention of UTIs. Probiotics support the body’s normal flora, and it is theorized that probiotics form a barrier against pathogens ascending the urinary tract, preventing the adherence, growth, and colonization of the urogenital epithelium by uropathogenic bacteria.14,15 To date, data regarding a protective effect of probiotics against future UTIs have been inconsistent, and additional large, well-designed studies are needed to determine the effectiveness of probiotics.14
Management: Nonprescription Products
Active ingredients found in OTC urinary tract analgesics include phenazopyridine hydrochloride, methenamine, and sodium salicylate (TABLE 1). Phenazopyridine, which provides relief from the pain, burning, itching, and urgency of UTIs, is available in both prescription (100-mg and 200-mg tablets) and OTC form (95-mg and 97.5-mg tablets). The recommended OTC dosage is two tablets three times daily during or after meals with a full glass of water for up to 2 days. Patients with kidney disease or an allergy to dyes should not take this medication. Patients should be advised that their urine may become reddish-orange in color, which is not harmful but can stain clothing. Common adverse effects (AEs) include headache, dizziness, and upset stomach.
Methenamine (an antibacterial) and sodium salicylate (a nonsteroidal inflammatory drug ) work in conjunction with one another; sodium salicylate stabilizes the urine pH, allowing methenamine to slow the growth of bacteria along the urinary tract and control the UTI. The recommended dosage is two tablets three times daily. Patients should be advised not to take this product if they are allergic to salicylates, are on a low-sodium diet or anticoagulant therapy, or have stomach problems.
Patients may also take pain relievers, such as NSAIDs or acetaminophen, for general relief of UTI-associated pain.
Role of the Pharmacist
It is imperative that pharmacists urge patients who present with UTI symptoms to consult with their healthcare provider as soon as possible to receive appropriate care. Pharmacists should counsel patients on nonpharmacologic treatments and present the option of nonprescription products and UTI home test kits. Patients who decide to use UTI home test kits should be advised on how to avoid inaccurate results and to discuss their results with their healthcare provider. Patients who decide to use OTC urinary tract analgesics should be counseled on the recommended maximum dosage and duration and on common AEs. It is imperative to remind patients that these products are intended only to provide relief of pain and other related symptoms until the healthcare provider is seen. These products do not eradicate bacteria or replace the use of antibiotic treatment, and they should not be used as monotherapy.
What Causes UTIs?
The bacterium that causes most UTIs is Escherichia coli. UTIs can affect both men and women, but they are more common in women. Although UTIs can affect anyone, some factors that can increase your chance of contracting a UTI include sexual intercourse, menopause, spermicides, pregnancy, older age, obesity, genetics, and antibiotic use.
How Can I Tell if I Have a UTI?
Not all UTIs have obvious symptoms, but signs and symptoms of a possible UTI include the need to urinate often, pain and burning sensations during urination, low fever, nausea, vomiting, feeling ill, and back or abdominal pain. You may also notice that your urine is bloody, cloudy, or odorous.
See your doctor immediately if you think you have a UTI, or ask your pharmacist about purchasing a UTI test kit. If you decide to use the take-home UTI test strips, follow the instructions carefully and be sure to discuss your test results with your doctor.
What Can I Take to Relieve Pain?
Phenazopyridine hydrochloride may relieve your pain, burning, itching, and urgency to urinate within 20 minutes. Avoid taking it if you have kidney disease or are allergic to dyes. Do not worry if your urine turns reddish-orange when you take this medication. This common effect is not harmful, but it can stain clothing.
Methenamine (an antibacterial agent) and sodium salicylate (a nonsteroidal inflammatory drug ) work together to slow bacterial growth along the urinary tract and to control the UTI. Do not take this medication if you are allergic to aspirin, are on a low-sodium diet or anticoagulant therapy, or have stomach problems.
You can also take other pain relievers, such as NSAIDs (aspirin, ibuprofen, naproxen, celecoxib) or acetaminophen (Tylenol).
What Natural Supplements Can I Take to Prevent Another UTI?
There is little evidence that natural supplements can prevent UTIs, but you can try cranberry supplements or probiotics. Cranberries contain antioxidants that may help prevent bacteria in the urinary tract from sticking to the walls of the urinary tract. Drinking 10 to 30 oz of cranberry juice per day may be beneficial. Probiotics may help prevent UTIs by supporting the body’s natural microorganisms in the flora.
What Steps Can I Take to Prevent Another UTI?
Drink lots of water, urinate before and after sexual activity, change tampons regularly, wipe from front to back, wear cotton underwear and loose-fitting clothing, and take showers instead of baths.
Remember, if you have questions, Consult Your Pharmacist.
To comment on this article, contact [email protected]
When you have a urinary tract infection, you’ll do anything to find relief, but before you try over-the-counter AZO, you should know whether it’s safe and effective.
If you’ve heard friends talk about AZO but you’re unsure how it works, here’s some background: AZO uses an active ingredient called phenazopyridine hydrochloride to soothe the bladder, especially the mucosal lining, which can become irritated when you have a UTI, Jennifer Linehan, MD, associate professor of urology and urologic oncology at the John Wayne Cancer Institute at Providence Saint John’s Health Centre in Santa Monica, CA, told POPSUGAR. This helps to relieve the burning and urgency associated with a UTI.
Generally, AZO is considered safe in small doses. “It turns the urine bright orange, but this is not harmful,” Jennifer Landa, MD, an ob-gyn at BodyLogicMD in Orlando, FL, told POPSUGAR. “Other side effects could include itching, nausea, headache, indigestion.” Like any medication, you could be allergic to AZO and have an anaphylactic reaction, but that isn’t as common. And while there’s some concern for the liver, you should be fine as long as you don’t take it for more than two days. The only exception: “It probably should be avoided in those with kidney or liver disease,” Dr. Landa said, as well as a disorder called G6PD deficiency.
Otherwise, AZO is only risky if it’s taken in place of antibiotics. “If you have a UTI, you usually need antibiotics to kick it,” Dr. Landa said. “AZO can be helpful while you’re waiting for the antibiotic to work to treat the UTI since the symptoms can be difficult to bear.” In fact, your doctor may even suggest taking it for a couple days after your visit.
Image Source: Getty / juandiegojr
Medically reviewed by Drugs.com on Apr 15, 2019 – Written by Cerner Multum
- Side Effects
What is Azo-Standard?
Azo-Standard is a pain reliever that affects the lower part of your urinary tract (bladder and urethra).
Azo-Standard is used to treat urinary symptoms such as pain or burning, increased urination, and increased urge to urinate. These symptoms can be caused by infection, injury, surgery, catheter, or other conditions that irritate the bladder.
Azo-Standard will treat urinary symptoms, but this medication will not treat a urinary tract infection.. Take any antibiotic that your doctor prescribes to treat an infection.
Azo-Standard may also be used for purposes not listed in this medication guide.
You should not use Azo-Standard if you have kidney disease.
You should not use Azo-Standard if you are allergic to it, or if you have kidney disease.
To make sure Azo-Standard is safe for you, tell your doctor if you have:
a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency.
FDA pregnancy category B. Azo-Standard is not expected to harm an unborn baby. Do not use Azo-Standard without a doctor’s advice if you are pregnant.
It is not known whether phenazopyridine passes into breast milk or if it could harm a nursing baby. Do not use this medicine without a doctor’s advice if you are breast-feeding a baby.
How should I take Azo-Standard?
Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Take Azo-Standard after meals.
Drink plenty of liquids while you are taking Azo-Standard.
Azo-Standard will most likely darken the color of your urine to an orange or red color. This is a normal effect and is not harmful. Darkened urine may also cause stains to your underwear that may be permanent.
Azo-Standard can also permanently stain soft contact lenses, and you should not wear them while taking this medicine.
Do not use Azo-Standard for longer than 2 days unless your doctor has told you to.
This medication can cause unusual results with urine tests. Tell any doctor who treats you that you are using Azo-Standard.
Store at room temperature away from moisture and heat.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking Azo-Standard?
Do not use this medication while wearing soft contact lenses. Azo-Standard can permanently discolor soft contact lenses.
More about Azo-Standard (phenazopyridine)
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Drug Interactions
- En Español
- 13 Reviews
- Drug class: miscellaneous genitourinary tract agents
- Azo-Standard (Advanced Reading)
Other brands: Pyridium, Azo Urinary Pain Relief, Uristat, Baridium, … +6 more
- Phenazopyridine Hydrochloride (AHFS Monograph)
- … +1 more
- Interstitial Cystitis
GENERIC NAME: SULFISOXAZOLE WITH PHENAZOPYRIDINE – ORAL (sull-fih-SOX-uh-zole WITH fen-aze-oh-PEER-ih-deen)
BRAND NAME(S): Azo-Gantrisin
Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage
USES: This combination of medication is used to treat infections of the urinary tract (kidney, bladder). Sulfisoxazole is a sulfa type antibiotic effective in treating a wide variety of infections. Phenazopyridine relieves the pain associated with urinary tract infections.
HOW TO USE: Take each dose with a full glass of water and drink plenty of fluids while taking this medication. Antibiotics work best when the amount of medicine in your body is kept at a constant level. Do this by taking the medication at evenly spaced intervals throughout the day and night. Continue to take this medication until the full prescribed amount is finished even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow resulting in a relapse of the infection.
SIDE EFFECTS: This medication may cause stomach upset, diarrhea, nausea, headache or vomiting during the first few days as your body adjusts to the medication. If these symptoms persist or become severe, inform your doctor. This may cause urine to be orange-brown in color. This is not a cause for concern and will disappear when the medication is stopped. Rarely, this medication can cause serious, even fatal, side effects such as a severe peeling skin rash known as Stevens- Johnson syndrome, blood disorders (e.g., agranulocytosis, aplastic anemia), or liver damage. Seek immediate medical attention if you develop any of the following symptoms: skin rash or blisters, unusual fatigue, persistent sore throat or fever, yellowing eyes or skin, dark urine, abdominal pain. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Be sure doctor knows your complete medical history, including: allergies (especially drug allergies). This medication may make you more sensitive to the sun. Avoid prolonged sun exposure; use a sunscreen and wear protective clothing when outdoors. This medication can affect the results of some diabetic urine testing products (cupric sulfate-type). Consult your doctor or pharmacist for recommendations. This medicine should be used during pregnancy only if clearly needed. Since small amounts of the drug appear in breast milk, consult with your doctor before breast-feeding.
AZO Yeast Infection Symptom Treatment Tablets60.0ea
Relieves Symptoms Now!
- Helps Prevent Future Occurrences
- Homeopathic Medicine
- Relief for Yeast Infection Symptoms
- In a Probiotic Base
- Lactose Free
- Pharmacist Recommended
The Leading Over-the-Counter Tablet for Relief & Prevention of Yeast Infection Symptoms
Relieve symptoms with AZO Yeast® – the homeopathic yeast infection symptom treatment to relieve symptoms of a vaginal yeast infection and helps protect from future recurrences when taken regularly.
- Convenient Tablets, a Safe Oral Complement to Traditional Antifungal Vaginal Creams
- Relieves Symptoms Like Itching, Burning & Swelling
- Ingredients Recognized By the Homeopathic Pharmacopoeia of the United States
- When Taken Daily, Natural, Active Ingredients Work with the Body to Prevent Future Recurrences
Please note, due to natural ingredients, this product’s color may vary.
Made in USA
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Take orally. If you have an infection, take one tablet three times a day as long as symptoms persist. Can be used in conjunction with antifungal vaginal creams, ointments or suppositories. To prevent future occurrences, take one tablet per day regularly.
Other Information: Store at room temperature. Do not expose to excessive heat, humidity or direct sunlight.
© 2014 Amerifit Brands
Azo-Standard (phenazopyridine) Drug Interactions
A total of 25 drugs are known to interact with Azo-Standard (phenazopyridine).
- 6 major drug interactions
- 19 moderate drug interactions
Show all medications in the database that may interact with Azo-Standard (phenazopyridine).
Check for interactions
Type in a drug name to check for interactions with Azo-Standard (phenazopyridine).
Most frequently checked interactions
View interaction reports for Azo-Standard (phenazopyridine) and the medicines listed below.
- Benadryl (diphenhydramine)
- Cipro (ciprofloxacin)
- Cymbalta (duloxetine)
- Lipitor (atorvastatin)
- magnesium oxide
- Tylenol (acetaminophen)
- Vitamin B12 (cyanocobalamin)
- Vitamin C (ascorbic acid)
- Vitamin D3 (cholecalciferol)
- Xanax (alprazolam)
- Zyrtec (cetirizine)
Azo-Standard (phenazopyridine) disease interactions
There are 3 disease interactions with Azo-Standard (phenazopyridine) which include:
- G-6-PD deficiency
- renal dysfunction
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- En Español
- 13 Reviews
- Drug class: miscellaneous genitourinary tract agents
- Interstitial Cystitis
Drug Interaction Classification
These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
No interaction information available.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Treating Yeast Infections and Drug Interactions
Medication interactions can be a serious issue, and it’s important to educate yourself about certain kinds of drug interactions. Did you know that for women who take medications on a regular basis—like oral contraceptives or medicines for treating diabetes or high cholesterol—when treating a yeast infection, there’s more to think about than just eliminating symptoms? For these women, MONISTAT® may be a safer choice. This is because topical antifungals cause fewer drug interactions within the body because they work at the site of the infection, not in the bloodstream.
Studies have shown that oral antifungals such as fluconazole (Diflucan®) have been associated with abnormal elevations of liver enzymes. Because the body metabolizes fluconazole in the liver, interactions can occur if you take fluconazole along with other medications that are also metabolized in the liver.1 Even if you take just one tablet, fluconazole remains in your body for days. Before you take fluconazole to treat a yeast infection, check with your healthcare professional or pharmacist about potential interactions with medicines you may already be taking, or check for medication interactions online. This is especially important if you experience recurrent vaginal yeast infections, since your healthcare professional may be likely to prescribe multiple doses of fluconazole. 1
MONISTAT® is Appropriate for More Women
Remember, topical antifungal creams like MONISTAT® cause fewer side effects throughout the body because they work in the vagina, at the site of the yeast infection. MONISTAT®, with the active ingredient miconazole, is a suitable treatment option for a wider range of women, including those who are:
- Taking oral contraceptives
- Taking antidiabetic drugs and other drugs metabolized in the liver
Which MONISTAT® Product is Right for You?
Monistat® 1 Combination Pack is a single-dose product (1200 mg of miconazole nitrate) which may be the perfect solution for busy women with active lifestyles. Available in Ovule® form. Use as directed.
MONISTAT® 3 is a great treatment option for women who want a less concentrated treatment (200 mg of miconazole nitrate per dose) that provides consistent treatment and relief at moderate dosage levels. Available in Ovule®, cream and suppository forms. Use as directed.
The MONISTAT® 7 suite of products is the original formula (100 mg of miconazole nitrate per dose), with smaller doses of the active ingredient evenly distributed throughout the week at bedtime. The CDC recommends 7-day treatment for pregnant women and diabetic women (consult a doctor before use). Available in cream form. Use as directed.
Opinions, content and any information expressed on or linked with this website, are intended to be general in nature and do not constitute medical advice, diagnosis or treatment. Always seek medical advice from your professional healthcare provider.