Grammidine

Grammidin is a combination drug containing the antibiotic gramicidin C and the antiseptic cetylpyridinium chloride. Gramicidin C is a cyclic peptide antibiotic that is used to treat infections caused by susceptible microorganisms and is effective as an antibiotic in topical applications, such as sore throats and pharyngitis (Geppe et al., 2020). Cetylpyridinium chloride acts as an antiseptic, killing bacteria and keeping the area of application clean (Rembe et al., 2019). This combination makes grammidin effective in the treatment and prevention of infections in the mouth and throat.

Indications Grammidine

1. Throat: Grammidin can be recommended for the treatment of various throat infections such as pharyngitis, laryngitis, tonsillitis and sore throat. It helps reduce inflammation, soreness and irritation in the throat caused by bacterial infections.
2. Oral Cavity: The drug can be used to treat stomatitis (inflammation of the oral mucosa), gingivitis (inflammation of the gums) and other oral infections. It helps fight bacteria that can cause these conditions and improves overall oral health.
3. Prevention: Grammidin can also be used to prevent throat and mouth infections, especially in people at increased risk of infection, such as exposure to infectious agents or after throat surgery.

Release form

1. Gargle: This is a liquid that you dilute in water and use to gargle.
2. Oral lozenges: These are tablets that dissolve in the mouth. They usually contain active ingredients and additives to relieve sore throat and suppress bacteria.
3. Sprays: This is a form that is usually applied directly to the back of the throat using a spray bottle.

Pharmacodynamics

1. Gramicidin C dihydrochloride:

   • Gramicidin C is an antimicrobial agent that is commonly used to fight bacterial infections in the mouth and throat.
   • It works by destroying bacterial cells by disrupting the cytoplasmic membrane, resulting in the death of the bacteria.
   • Gramicidin C is effective against a broad spectrum of bacteria, including gram-positive and gram-negative organisms.

2. Cetylpyridinium chloride:

   • Cetylpyridinium chloride is an antiseptic and antimicrobial agent that is also widely used to treat various mouth and throat infections.
   • It has disinfectant properties and works by destroying the cell membrane of bacteria and viruses.
   • Cetylpyridinium chloride also has antifungal properties and may be effective in fighting fungal infections.

Pharmacokinetics

In general, the pharmacokinetics of both active components can be described as follows:

1. Gramicidin C dihydrochloride: Gramicidin C is an antibacterial agent that is commonly used to treat infections in the mouth and throat. After application, it can be adsorbed onto the mucous membrane and exert local antimicrobial action against various types of bacteria.
2. Cetylpyridinium chloride: This is another antiseptic that is often used to combat bacteria and fungi in the oral cavity. After application, it can also be adsorbed onto the mucous membrane and provide local antimicrobial action.

Dosing and administration

1. Rinsing solution:

   • Dissolve the specified amount of the preparation in 15-30 ml of warm water.
   • Rinse with the solution for 30 seconds to 1 minute.
   • Repeat the procedure 3-4 times a day or as recommended by your doctor.
   • Do not swallow the solution.

2. Lozenges:

   • Allow the tablet to dissolve in your mouth.
   • Usually one tablet is dissolved in the mouth every 2-3 hours, but follow the directions on the package or your doctor's recommendations.
   • Avoid swallowing tablets whole.

3. Sprays:

   • Spray the indicated amount of spray onto the back of the throat.
   • Use as needed, usually 3-4 times daily or as recommended by a healthcare professional.

Use Grammidine during pregnancy

Like other medications, it is important to discuss the use of Grammidin during pregnancy with your doctor. Your doctor will be able to assess the risks and benefits for you and your baby, taking into account your individual situation.

Typically, when prescribing medications during pregnancy, the doctor will try to minimize the use of medications to the minimum necessary to avoid potential risks to the baby's development. However, in some cases, if the benefits of using a drug outweigh the potential risks, the doctor may recommend its use.

Contraindications

1. Hypersensitivity or allergic reaction: People with a known allergy to gramicidin C, cetylpyridinium chloride or other components of the drug should avoid using it.
2. Children under 12 years: Some forms of Grammidin are not recommended for use in children under 12 years of age without a doctor's advice.
3. Pregnancy and breastfeeding: If you are pregnant or breastfeeding, you should consult your doctor before using Grammidin to ensure it is safe.
4. Long-term use: Grammidin should not be used for a long period of time without the advice of a doctor, as this may lead to the development of resistance to the drug or other problems.
5. Use in patients with thyroid disease: Use with caution in patients with thyroid disease, as some components of the drug may affect thyroid function.

Side effects Grammidine

Grammidin is generally well tolerated, but like any medication, it can cause side effects. Based on research data, side effects of Grammidin, which contains gramicidin C and cetylpyridinium chloride, are rare and usually pass easily.

In one multicenter study evaluating the efficacy of Grammidin spray in children with non-streptococcal acute tonsillopharyngitis, no adverse effects related to pharmacotherapy were reported (Geppe et al., 2020).

It is important to note that the drug is applied locally and its systemic effects are minimal, which may contribute to a low likelihood of adverse reactions. However, if unusual symptoms or allergic reactions occur, it is recommended to stop using the drug and seek medical attention.

Overdose

Overdose symptoms can vary depending on many factors, including the amount of drug taken and individual characteristics of the body. They can include nausea, vomiting, dizziness, abnormal heart rhythms, itching or burning in the throat, allergic reactions and other unpleasant symptoms.

Interactions with other drugs

1. Other antimicrobials: When used simultaneously with other antimicrobials, especially those of local action, their effects may be enhanced or weakened due to possible competitive action or interaction at the level of adsorption.
2. Local anesthetics: The anesthetic effect may be enhanced when used simultaneously with local anesthetics.
3. Drugs that reduce stomach acidity: Since Grammidin is applied topically in the mouth, changes in stomach acidity should not usually have a significant impact on its effectiveness or interactions with other drugs.
4. Systemic antifungal or antibiotic drugs: Although Grammidin is applied topically, systemic effects may occur due to the absorption of its components into the bloodstream through the mucous membrane. In such cases, it is important to be careful when using systemic antifungal or antibiotic drugs to prevent possible adverse interactions.