For sore throat: lozenges, tablets and lozenges (in tables and figures)

Outbreaks of colds often occur in the autumn-winter period and early spring. Symptoms such as pain when swallowing, sore throat, tingling lead a person either to an appointment with a therapist (otolaryngologist) or directly to a pharmacy.

To treat a sore throat, oral cavity and further protect against pathogens, the drug Imudon and its analogs are used. To understand the variety of these drugs, you need to familiarize yourself with the list of Imudon substitutes and instructions for use.

pharmachologic effect

Imudon is a unique immunomodulator that contains lysates or a combination of bacterial antigens that are causative agents of sore throat. In the body, bacterial lysates do not cause the development of infection, but make the body’s own immunity work.

What are the advantages of Imudon?

1. Stimulates 4 factors responsible for immunity:

• in saliva the content of an enzyme with a bactericidal effect - lysozyme - increases;
• activates phagocytes - cells that capture and digest pathogens;
• increases the number of immunoglobulin A molecules, which provides local immunity;
• The production of interferon, which prevents the penetration of viruses, increases.

1. Protects the throat and oral cavity from infectious agents.
2. Treats and prevents relapses.
3. Used in otolaryngology and dentistry.
4. Shortens the period of illness.
5. Effective when the first symptoms occur and at the peak of the disease.

Contraindications and side effects

Imudon is not recommended for use in case of individual intolerance to active or auxiliary substances, as well as in case of:

• Treatment of patients under 3 years of age.
• Therapy for people with autoimmune diseases.

The drug is well tolerated. According to patient reviews, in a number of cases the development of:

• Allergic reactions: rash, urticaria, angioedema.
• Disorders of the gastrointestinal tract: nausea, vomiting, pain impulses in the abdominal area.
• Increased body temperature.
• Cough and exacerbations of bronchial asthma.
• In isolated cases, erythema nodosum, thrombocytopenia, and hemorrhagic vasculitis occurred.

If patients notice the occurrence of these or any other undesirable side effects, they should inform their doctor as soon as possible.

Imudon - instructions for use

Manufacturer: Pharmstandard-Tomskkhimpharm, Russia
Dosage form: lozenges

Ingredients: bacterial lysates

Imudon is approved for children from 3 years of age, up to 6 tablets per day.

For adults and adolescents over 14 years old - a tablet every hour (8 pieces per day).

The duration of therapy is 10 days; prophylaxis will require 20 days.

The regimen for taking Imudon for the purpose of prevention is the same for all age groups - 6 pieces per day at regular intervals.

How to take Imudon - before or after meals?

It is advisable to take Imudon after meals and not drink or rinse your mouth for 1 hour so as not to reduce the effect. Imudon tablets can only be dissolved in the mouth until completely dissolved.

Imudon is contraindicated in pregnant and lactating women, since there are no reliable clinical studies on the safety of the drug for women and children.

Patients with bronchial asthma should refrain from taking Imudon to avoid exacerbations.

Undesirable side effects when taking Imudon are rare. Dyspeptic gastrointestinal disorders and allergic reactions to the skin may occur. Over-the-counter drug.

Acute inflammatory diseases of the upper respiratory tract are extremely common both in the adult population and in childhood, and in a significant percentage of these clinical cases there is a pathological process in the oropharynx. The main reason for visiting a doctor in this case is a sore throat; this complaint comes to the fore in the clinical picture of acute pathology of the pharynx and significantly reduces the quality of life. Intense pharyngeal pain is explained by the peculiarities of the innervation of this area.

Currently, the previously used definitions of “acute pharyngitis” and “tonsillitis” are united by the diagnostic term “acute tonsillopharyngitis”, since there is almost always a combined lesion of the mucous membrane and lymphoid structures of the pharynx, however, in our country the previous terminology is often used, distinguishing between acute pharyngitis and acute tonsillitis (angina) as different nosological forms. The etiological factors of acute infectious processes in the pharynx of tonsillopharyngitis are different, the disease can be caused by viruses, bacteria and, less often, fungi; there are certain characteristics of the causative agents of an acute process in the pharynx, depending on the age of the patient. Thus, in children under 5 years of age, the most common cause of the development of this pathology is respiratory viruses, in particular adenovirus, rhinovirus, parainfluenza virus, enteroviruses (Coxsackie B virus), Epstein-Barr virus and some others [1, 2]. From 5 to 15 years of age, acute pathology of the pharynx is quite often caused by β-hemolytic streptococcus of group A (up to 30%), Streptococcus pneumoniae

,
Arcanabacterium haemolyticum
,
Mycoplasma pneumoniaae
and
Chlamydia pneumoniae
[3–6].
In adults, acute inflammatory changes in the pharynx in 15% of cases are represented by a bacterial process, in the rest - viral. In rare cases, this disease can be caused by fungi - Candida albicans
,
Leptotrix buccalis
. This form of the disease can develop after a long course of therapy with systemic antimicrobial drugs, with long-term use of inhaled glucocorticosteroids, as well as against the background of immunodeficiency.

One of the key issues in the treatment of patients with acute infectious and inflammatory diseases of the pharynx is the need to prescribe systemic antibiotic therapy. Until now, unjustified prescription of systemic antibacterial drugs is often observed, especially in pediatric practice. Inappropriate use of antimicrobial agents accelerates the formation of drug resistance in microorganisms and increases the risk of side effects, in particular from the gastrointestinal tract, which can lead to a negative patient reaction to treatment.

For the differential diagnosis of bacterial and viral pharyngeal inflammatory processes, clinical scales are used, for example McIsaac or Centor, which include the assessment of several clinical signs, including the presence of exudate on the surface of the palatine tonsils, the severity of regional lymphadenitis, fever above 38 ° C, the presence of cough and others respiratory symptoms. Bacteriological analysis of material from the surface of the palatine tonsils and the posterior wall of the pharynx with determination of sensitivity to antibiotics and bacteriophages allows us to judge with the greatest confidence the nature of the disease, however, this study in practical healthcare conditions takes quite a lot of time. Currently, the process of diagnosing acute inflammatory diseases of the pharynx, in particular streptococcal etiology, has been significantly simplified thanks to the introduction into practice of rapid tests for identifying the pathogen. Modern methods of express diagnostics make it possible to resolve the issue of the need to prescribe a systemic antibiotic within a few minutes, are convenient to use in an outpatient setting and when calling a doctor at home, are safe, easy to perform and are economically accessible [7].

If there is a high probability or confirmation of the streptococcal nature of acute tonsillitis, the doctor may prescribe a systemic antibacterial drug. The drug of choice for the treatment of acute tonsillopharyngitis caused by group A β-hemolytic streptococcus is amoxicillin. In some cases, phenoxymethylpenicillin, amoxicillin-clavulanate, and cephalosporins are used. The course of treatment is 10 days. For allergies to β-lactams, macrolides are prescribed; lincosamides are reserve drugs [6]. In the case of viral etiology of acute pharyngitis, systemic antiviral drugs may be prescribed according to indications.

Topical medications occupy an important place in the treatment of patients with acute diseases of the pharynx. Currently, they are widely available in various forms - lozenges, lozenges, sprays, rinses. The advantages of local therapy are the effective effect of the drug on the site of inflammation, minimal systemic bioavailability, and low risk of developing microbial resistance [5, 6]. Considering the huge number of topical drugs of different composition and form for the treatment of patients with pharyngeal pathology, some of their features should be taken into account. Thus, the most effective dosage form compared to rinsing solutions are lozenges and sprays, which provide longer exposure of the active substance.

According to γ-scintigraphy, a drug labeled with a radioisotope remains longer on the mucous membrane of the pharynx and oral cavity when using lozenges and aerosol/spray than when using a rinse [8]. In addition, rinsing solutions, which have a toxic effect when taken orally, can be accidentally swallowed by the patient in significant quantities; this fact is especially relevant when treating children.

It is necessary to pay close attention to the composition of the drugs. Thus, medications containing herbal components should not be prescribed to patients with allergies. The presence of non-steroidal anti-inflammatory drugs in the composition can negatively affect the condition of people with the aspirin triad, diseases of the gastrointestinal tract and pathology of the blood coagulation system. A number of components, for example propolis, iodine, chlorhexidine, can cause irritant and toxic effects. It is important to consider that the problem of microbial resistance is relevant not only in the case of systemic antimicrobial therapy, but also when using topical agents, which often include antiseptics. According to a study carried out at the Institute of Surgery named after. A.V. Vishnevsky RAMS, currently the resistance of a number of strains of Staphylococcus aureus

to furatsilin reaches 95%, miramistin - 81%, 0.02% chlorhexidine solution - 15%.
For Candida albicans,
resistance to miramistin was also observed in 89% of cases, resistance to 0.02% chlorhexidine solution was observed in 14-43%, and contamination of the furatsilin solution with this type of fungus was detected in 58% of cases [9-11].

Considering the above, one of the best options for local treatment of patients with acute inflammatory diseases of the pharynx is the Russian-made drug Grammidin. Grammidin contains the local antibiotic gramicidin C and the antiseptic cetylpyridinium chloride, which exists in the form of lozenges and sprays. To date, Grammidin spray is the only topical drug for the treatment of patients with acute inflammatory processes in the pharynx, which contains an antibiotic.

Gramicidin C is a broad-spectrum antibiotic obtained from the microbial bacillus Bacillus brevis

. It has activity against gram-positive and gram-negative aerobes and anaerobes, in particular streptococci and staphylococci. The mechanism of action of gramicidin C is bactericidal, achieved by destroying the cytoplasmic membrane of bacteria. Over the many years of use of gramicidin C, no data have been obtained on the development of microbial resistance to it [12-19]. The antiseptic cetylpyridinium chloride has a bactericidal effect on gram-positive and gram-negative bacteria and is effective against some viruses and fungi. Due to its significant moisturizing ability and surface-active properties, cetylpyridinium chloride penetrates well into all parts of the oral cavity and pharyngeal mucosa, inhibiting the growth of pathogenic bacteria, fungi and viruses, while having virtually no effect on the normal microflora and does not cause dysbiosis. The high effectiveness of Grammidin is due, among other things, to the synergistic action of its constituent components. It is important to note that gramicidin C in combination with cetylpyridinium chloride has a pronounced effect not only on pathogenic bacterial flora, but also on fungi and viruses, which actually determines the possibility of using the drug Grammidin for any form of acute inflammatory process in the pharynx [20-23].

When choosing a drug, an important aspect is its activity against microbial biofilms. Biofilms are structured communities of microorganisms (up to 35% of the composition), adhered to a biotic or abiotic surface, surrounded by a polymer matrix (up to 95% of the biofilm composition) and possessing a complex system for regulating physiological processes based on intercellular communication [23–25]. For example, up to 48 species of microorganisms can be represented in the microbial communities on the palatine tonsils, which form in 85% of patients with chronic tonsillitis [25]. In a biofilm, bacteria exchange antibiotic resistance genes; its matrix plays an important role in this process. The latter makes it difficult for the antibiotic to penetrate deep into the biofilm and accumulates a number of enzymes that can destroy the drug molecule [24–26].

An important feature of one of the constituent components of Grammidin - cetylpyridinium chloride - is the ability to penetrate well into biofilms: according to research results, up to 73% of biofilm bacteria exposed to a solution of cetylpyridinium chloride were damaged [27]. In the control group, where the biofilm was exposed to a sterile salt solution, the level of damaged bacteria was only 25.7%. It has also been proven that cetylpyridinium chloride is capable of thinning the biofilm by an average of 34–43% [27–31].

Grammidin is available in the form of lozenges and sprays. Lozenges: Grammidin neo - with mint flavor, Grammidin for children - with ripe raspberry flavor, there is a form with an anesthetic - oxybuprocaine - Grammidin neo with anesthetic, lozenges with mint flavor. Grammidin in the form of a spray exists in the forms Grammidin spray, Grammidin spray for children, Grammidin spray with anesthetic (like tablets, it contains oxybuprocaine as an anesthetic). Grammidin in the form of lozenges can be used in children from 4 years of age and adults, Grammidin spray and spray with anesthetic - in patients from 18 years of age, Grammidin spray for children - in patients from 6 years of age.

A convenient dosage regimen and various release forms allow this drug to be used in both adult patients and children. Tablets intended for children have a pleasant taste of ripe raspberries, which increases the adherence of young patients to treatment. Grammidin for children in the form of a spray can increase the effectiveness of therapy in children who find it difficult to dissolve the tablet for a long time, or who immediately chew it without maintaining the proper exposure time to the drug [19].

The effectiveness of Grammidin has been studied in a number of clinical studies in children and adult patients. Thus, the results of a study involving 196 children demonstrated the high effectiveness and safety of the use of Grammidin for the treatment of patients with acute inflammatory diseases of the pharynx not associated with group A β-hemolytic streptococcus, which confirms the wide therapeutic possibilities of the combination of cetylpyridinium chloride with gramicidin C [19].

In 2011, a study was conducted involving a large number of patients, which assessed the effectiveness and safety of the use of the drug Grammidin neo with an anesthetic compared with three other drugs for the local treatment of acute inflammatory diseases of the pharynx. On the 3rd day, almost all patients who received Grammidin neo with an anesthetic noted the absence of sore throat. On the 8th day of observation, this group had the highest rate of convalescence - 96.7%. In addition, in the main group of patients, a significant percentage of pathogen elimination was observed, according to bacteriological examination before the start of treatment and at the end of the course of therapy - 74%. In all clinical cases, the drug was well tolerated [28].

A study conducted in 2015 on the possibility of using Grammidin for children in the treatment of acute infectious and inflammatory processes in the pharynx in children also demonstrated high effectiveness. The duration of therapy was 8 days, it was shown that Grammidin for children contributed to the disappearance of local signs of inflammation, and also relieved sore throat from the first days of use. On days 4-5, the disappearance of all assessed signs was observed in 14% of patients; on days 7-8 this figure was 90%. In addition to the topical effect, Grammidin for children helped reduce body temperature, which confirms its indirect anti-inflammatory activity. All patients showed good tolerability of the drug [29].

Also of interest are the results of an open multicenter study of the effectiveness and safety of the drugs Grammidin spray with anesthetic and Grammidin neo with anesthetic, lozenges. The study included 146 patients with infectious and inflammatory diseases of the pharynx (acute pharyngitis, acute nasopharyngitis, chronic pharyngitis in the acute stage). Using the random number method, patients were divided into two groups comparable by gender, age, and severity of clinical manifestations of the disease.

When patients consulted a doctor, as well as on the 3-4th and 8-9th days of the disease, the pharyngoscopic picture, the severity of sore throat, and the intensity of the general intoxication syndrome were assessed using clinical 4-point scales.

It was noted that 30 minutes after the first application, patients in both groups experienced a decrease in pain intensity by more than 1.5 times, and subsequently the trend towards a decrease in pain intensity persisted. The absence of sore throat after the first use of the drug was observed, on average, in half of all patients (45% in the group using the spray and 58% in the group using lozenges).

The assessment of the symptom “sore throat” on a 4-point scale 30 minutes, 1 and 2 hours after the start of therapy is presented in Fig. 1.

Rice. 1. Dynamics of the “sore throat” indicator in points.

The dynamics of changes in clinical signs during pharyngoscopy examination are presented in Fig. 2 and testifies

Rice. 2. Dynamics of catarrhal symptoms in points. about the effectiveness of the drug both in the form of a spray and in the form of lozenges [32].

In 2021 in Moscow, on the basis of the clinic of ear, nose and throat diseases of the First Moscow State Medical University named after. THEM. Sechenov conducted an open non-interventional study of the drug Grammidin spray dosed for the symptomatic treatment of sore throat in patients with chronic pathology of the ENT organs, which included 120 patients with the symptom “pain in the throat” and clinically diagnosed acute or acute chronic infectious-inflammatory diseases of the pharynx. The results of the study showed that already on the 1st day after use, patients noted a decrease in the severity of pain, burning in the throat, as well as painful sensations when swallowing. On the 7th—8th day of treatment, all symptoms of pharyngeal paresthesia were completely absent. Changes in the pharyngoscopy picture data corresponded to the dynamics of clinical symptoms. The severity of edema, hyperemia of the posterior pharyngeal wall, increase in lymphoid granules and lateral ridges significantly decreased already on the 4th day from the start of treatment. During the entire observation period, no adverse drug reactions were recorded [33].

Thus, the above research results prove the high effectiveness, safety and convenience of using the drug Grammidin in the treatment of children and adult patients with acute infectious and inflammatory diseases of the pharynx, which is due to the unique combination of active ingredients. The properties described above and the presence of various forms allow us to recommend Grammidin for widespread use in clinical practice.

The authors declare no conflict of interest.

The authors declare no conflicts of interest.

Information about authors

Svistushkin V.M. – e-mail; https://orcid.org/0000-0002-1257-9879

Nikiforova G.N. – e-mail; https://orcid.org/0000-0002-8617-0179

Shevchik E.A. – e-mail; https://orcid.org/0000-0002-0051-3792

Toporkova L.A. – e-mail; https://orcid.org/0000-0002-5534-8464

Corresponding author:

Toporkova L.A. — email

Svistushkin V.M., Nikiforova G.N., Shevchik E.A., Toporkova L.A. The effectiveness of topical drugs in the treatment of patients with acute inflammatory diseases of the pharynx. Bulletin of Otorhinolaryngology

. 2019;84(6):112-117. https://doi.org/10.17116/otorino201984061112

Analogues of Imudon

Imudon is a local immunomodulator that has no analogues in composition and area of ​​effect.

The drugs that will be discussed below as analogues or substitutes for Imudon have similar indications - diseases of the oral cavity and pharynx.

The price of Imudon depends on the number of tablets, the region of sale and pricing in a particular pharmacy. On average, a package of 24 tablets costs from 300 to 470 rubles, for a package of 40 tablets the price ranges from 490 to 700 rubles. You can get acquainted with analogues that are cheaper than Imudon in the table below.

Faringosept

Manufacturer: SAN-FARMA, Romania
Dosage form: lozenges

Ingredients: ambazone monohydrate

Imudon's analog Faringosept is a local antiseptic that suppresses the proliferation of gram-positive flora in the lesion. Has no effect on intestinal microflora. Used for pharyngitis, tonsillitis, as well as stomatitis and gingivitis.

Flaws:

• bacteriostatic rather than bactericidal effect (inhibits reproduction, but does not cause the death of pathogenic flora);
• the concentration in saliva necessary for the therapeutic effect is observed only on the 3rd–4th day of administration;
• It is recommended to abstain from food and drink for 3 hours after taking the tablets.

Immunal

Manufacturer: Sandoz, Slovenia
Dosage form: tablets, oral solution

Ingredients: Echinacea purpurea juice

Immunal is a plant analogue of Imudon based on an extract from echinacea juice. The immunostimulating effect of echinacea has been proven in numerous clinical studies.

Immunal relieves inflammation, suppresses the proliferation of viruses and bacteria. Unlike Imudon, the Immunal analogue is used to strengthen the immune system during frequent colds and long-term antibiotic therapy.

The drug has age restrictions for use up to 12 years and an impressive list of contraindications.

Dorithricin

Manufacturer: Medice Arzneimittel Pütter, Germany
Dosage form: lozenges

Ingredients: benzocaine + benzalkonium chloride + tyrothricin

A prescription analogue of Imudon, Dorithricin, is an antiseptic with a three-component composition. Affects some viruses, gram-positive bacteria and Candida fungus.

In addition to general indications with Imudon, it is used at the initial stage of sore throat, reducing pain when swallowing.

Contraindicated in children under 6 years of age.

Purpose depending on age

Imudon or Lizobakt – which is better?

Manufacturer: Bosnalek, Bosnia and Herzegovina
Dosage form: tablets

Ingredients: lysozyme hydrochloride + pyridoxine hydrochloride

Lizobakt is an analogue of Imudon from the group of antiseptics, supports normal local immunity.

Differences:

• Lysobact acts on the cause of sore throat;
• wide spectrum of action on Gram (+) and Gram (-) bacteria, viruses, fungi, but does not affect beneficial microflora;
• allowed during pregnancy and lactation;
• Lizobakt's indications are supplemented by herpetic lesions of the oral mucosa;
• enhances the effect of antibiotics.

Indications for analogues are similar (used for tonsillitis, pharyngitis, stomatitis).

Lizobact is used exclusively for treatment, and Imudon for both treatment and prevention.

For an adult working person, the advantage of the analogue will be a smaller frequency of administration: for Lizobakt - 3-4 times a day, for Imudon - 8 times.

Lysobact is indicated for children over three years of age.

The drugs belong to different pharmacological groups and have a different mechanism of action: Immudon enhances the body’s own defense, and Lizobact fights pathogenic microorganisms.

Accordingly, the answer to the question - what is best for the throat - should be approached individually, taking into account the characteristics of the patient and the severity of the disease.

Presence of sugar

* Allowed for diabetes.

The vast majority of local remedies for sore throats contain sugar, but there are still preparations with sweeteners, which differ in the size of the glycemic index (GI), i.e., in the effect on blood glucose levels, and in calorie content. Among all the sugar substitutes used in the group of drugs under review, only one, sucralose, is characterized by zero GI and calorie content. Aspartame, sorbitol, and mannitol also have a GI that does not exceed zero, but they contain several kilocalories per gram (1.4, 3.5, and 9, respectively). Patients with diabetes should take medications containing maltitol with caution: its GI is 25–35 units, and its calorie content reaches 13 kilocalories per gram. For comparison, the GI of milk sugar, which is most often used as a sweetener, reaches 46 (calorie content 16 kcal), and glucose - 100 units with a calorie content of 16 kcal/1 gram.

Imudon or Ismigen - which is better?

Manufacturer: Bruschettini, Italy
Dosage form: tablets

Composition: lysates of 8 bacteria

The Imudon analogue Ismigen is an immunostimulant, treats respiratory infections and protects against repeated episodes.

Advantages:

• supports local and systemic immunity;
• wide range of applications (diseases of the respiratory system);
• Convenient administration - once, in the morning on an empty stomach, 1 tablet under the tongue.

The disadvantage of Ismigen is the treatment of oral infections only as an auxiliary drug.

Thus, an intelligent choice in favor of one or another analogue can be made based on the patient’s exact diagnosis.

Imudon or Broncho-munal

Manufacturer: Lek, Slovenia
Dosage form: capsules 7 mg and 3.5 mg for children

Composition: substance OM-85 (mixture of bacterial lysates)

Broncho-munal is an analogue of Imudon from the group of immunostimulants. In combination with other medications, it is prescribed for acute respiratory tract infections and to protect against relapses of chronic bronchitis.

Analogues of Imudon Broncho-munal and Ismigen are similar in composition and action in the body, they differ in the form of release and the presence of Broncho-munal in a children's dosage, permitted from six months.

Broncho-munal has conflicting reviews about its use: some patients experienced side effects (diarrhea, abdominal pain, cough, rash), while others tolerated the drug well. Therefore, the attending physician will help you choose the appropriate drug after studying your medical history.

Flavors

Imudon or Grammidin - which is better?

Manufacturer: Valenta Pharmaceuticals, Russia
Dosage form: tablets

Ingredients: gramicidin C hydrochloride + cetylpyridinium chloride monohydrate

Grammidin Neo is a combined medicine for the treatment of the throat and oral cavity. The components in the analogue determine its antimicrobial and antiseptic activity.

It exhibits a bactericidal effect against most pathogens of throat infections and does not cause resistance.

Grammidin Neo alleviates pain, facilitates swallowing, relieves inflammation in sore throat and other acute conditions.

Grammidin Neo is approved for children from 4 years of age.

Side effects include allergic reactions to the components of the drug.

Which drug would be the best choice - Imudon or the Grammidin Neo analogue - depends on the patient’s disease picture.

Both analogues are suitable for the treatment of infections of the mucous membranes of the mouth and throat; for prevention - only Imudon for a course of 20 days.

Composition of multicomponent drugs for sore throat

Imudon or IRS 19

Manufacturer: Mylan Laboratories, France
Dosage form: nasal spray

Composition: bacterial lysates

IRS 19 is an immunostimulant, is of bacterial origin and exhibits antiviral and antibacterial activity. Spraying a nasal aerosol helps quickly develop a local immune response in the body.

Distinctive features of the IRS 19 analogue:

• manufactured dosage form – nasal spray;
• used for the treatment and prevention of infections of the upper respiratory tract, bronchi (rhinitis, sinusitis, tracheitis, bronchitis), but is not suitable for the oral cavity;
• allowed for infants from 3 months;
• high cost of the drug;
• it is necessary to comply with the storage conditions of the spray - temperature from 2 to 8 degrees.

The above differences between Imudon and its analogue IRS 19 will help you decide on the choice of a drug that meets the needs and demands of the patient.

It is important to remember that analogues of drugs are prescribed by a doctor based on treatment experience, medical examination and clinical recommendations for the management of a patient with a similar diagnosis.

Indications for use

According to the instructions for use, Imudon is used during treatment and prevention:

• Superficial and deep periodontal disease, glossitis, aphthous stomatitis.
• Dysbacteriosis of the oral cavity.
• Catarrhal and ulcerative gingivitis.
• Periodontitis in acute and chronic course.
• Pharyngitis.
• Chronic form of tonsillitis.
• Acute and chronic infectious or aphthous stomatitis.
• Traumatic or decubital lesions of the mucous membranes of the oral cavity.
• To prevent secondary infection before and after surgery in the oral cavity.

The drug is widely used by maxillofacial surgeons. The medicine can also be used for ulcers caused by dentures.