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gramicidin

R02AB30

Forms & Strengths

Ointment 0.5% (w/w)
Cream 0.5% (w/w)
Solution for inhalation 0.04% (w/v)
Eye drops 0.2% (w/v)
Nasal spray 0.1% (w/v)

Adult Dosing

Topical: apply thin film to affected area 2‑3×/day; max 2 weeks
Inhalation (CF): 0.1 mg/kg nebulized q6h (max 2 mg per dose)

Pediatric Dosing

Topical: same frequency as adults; avoid >12 y/o for >2 weeks
Inhalation (CF): 0.05 mg/kg nebulized q6h; dose capped at 1 mg per dose

Indications

Superficial bacterial skin infections (impetigo, infected eczema)
Otitis externa (topical)
Conjunctivitis (ophthalmic solution)
Adjunctive inhalation therapy in cystic fibrosis for Pseudomonas spp.

Mechanism of Action

Forms voltage‑gated cation channels in bacterial membranes
Disrupts ion gradients, causing rapid loss of K⁺ and Na⁺
Leads to bacterial depolarization and cell death

Contraindications

Known hypersensitivity to gramicidin or formulation excipients
Deep or systemic infections (ineffective)
Use on large body surface area in neonates or infants

Adverse Reactions

Local irritation, erythema, pruritus, contact dermatitis
Burning sensation in eyes or ears
Inhalation: cough, bronchospasm, transient wheeze
Rare systemic toxicity (nephro‑ or neuro‑) with excessive absorption

Drug Interactions

May act synergistically with other topical antibiotics (neomycin, bacitracin)
Avoid concomitant use with nephrotoxic agents if systemic absorption possible
No significant CYP450 interactions documented

Curated Content: Needs Vetting Before Put to Clinical Use