Efficacy of povidone-iodine nasal rinse and mouth wash in COVID-19 management: a prospective, randomized pilot clinical trial (povidone-iodine in COVID-19 management)

{ 'DOI': '10.1186/s12879-024-09137-y', 'ISSN': ['1471-2334'], 'URL': 'http://dx.doi.org/10.1186/s12879-024-09137-y', 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Objectives/Hypothesis</jats:title>\n' ' <jats:p>To assess the efficacy of 0.23% povidone-iodine (PVP-I) nasal rinses ' 'and mouth washes on detectability of the coronavirus disease 2019 (COVID-19) virus and cycle ' 'threshold (Ct) values in nasopharyngeal swabs.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Study design</jats:title>\n' ' <jats:p>This was an open-label, prospective, randomized, placebo-controlled ' 'clinical trial.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Setting</jats:title>\n' ' <jats:p>The study was conducted in King Saud University Medical City, Riyadh, ' 'Saudi Arabia, from August 2021 to July 2022.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>Participants diagnosed with SARS-CoV-2 were randomly assigned to one ' 'of three groups, with participants receiving either 0.23% PVP-I, 0.9% normal saline (NS) ' 'nasal rinses and mouth washes, or no intervention (control group). Nasopharyngeal swabs were ' 'taken 4, 8, 12, and 18 days after the first swab to measure the detectability of the virus ' 'and the Ct.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>A total of 19 participants were involved in this study. The mean ' 'viral survival was 9.8, 12, and 12.6 days for the PVP-I, NS, and control groups, ' 'respectively, with a statistically significant difference (<jats:italic>p</jats:italic>\u2009' '=\u20090.046). The Ct mean values were 23\u2009±\u20093.4, 23.5\u2009±\u20096.3, and ' '26.3\u2009±\u20095.9 at the time of recruitment and 25.2\u2009±\u20093.5, 15\u2009±\u2009' '11.7, and 26.9\u2009±\u20096.4 after 4 days for the PVP-I, NS, and control groups, ' 'respectively.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>When used continuously at a concentration of 0.23%, PVP-I showed ' 'promising results in terms of decreasing the pandemic burden by reducing the period of ' 'infectiousness and viral load. However, the use of PVP-I did not result in significantly ' 'different changes in the quality-of-life parameters in recently vaccinated and mild COVID-19 ' 'patients.</jats:p>\n' ' </jats:sec>', 'alternative-id': ['9137'], 'article-number': '271', 'assertion': [ { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'Received', 'name': 'received', 'order': 1, 'value': '6 October 2023'}, { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'Accepted', 'name': 'accepted', 'order': 2, 'value': '14 February 2024'}, { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'First Online', 'name': 'first_online', 'order': 3, 'value': '1 March 2024'}, {'group': {'label': 'Declarations', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 1}, { 'group': {'label': 'Ethics approval and consent to participate', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 2, 'value': 'The study was approved by the King Saud University Institutional Review Board ' 'and the Saudi Food and Drug Authority Clinical Trial Unit. All patients who met ' 'the inclusion criteria signed a written informed consent form that mentioned ' 'possible risks and benefits associated with the intervention.'}, { 'group': {'label': 'Consent for publication', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 3, 'value': 'Not applicable.'}, { 'group': {'label': 'Competing interests', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 4, 'value': 'The authors declare no competing interests.'}], 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-1236-2098', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Alsaleh', 'given': 'Saad', 'sequence': 'first'}, { 'ORCID': 'http://orcid.org/0000-0003-4754-0293', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Alhussien', 'given': 'Ahmed', 'sequence': 'additional'}, { 'ORCID': 'http://orcid.org/0000-0002-2495-7523', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Alyamani', 'given': 'Abduljabbar', 'sequence': 'additional'}, { 'ORCID': 'http://orcid.org/0000-0002-9655-9698', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Alhussain', 'given': 'Fahad', 'sequence': 'additional'}, { 'ORCID': 'http://orcid.org/0000-0003-2074-8916', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Alhijji', 'given': 'Ali', 'sequence': 'additional'}, { 'ORCID': 'http://orcid.org/0000-0002-5425-9531', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Binkhamis', 'given': 'Khalifa', 'sequence': 'additional'}, { 'ORCID': 'http://orcid.org/0000-0001-5075-7392', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Khan', 'given': 'Anas', 'sequence': 'additional'}, { 'ORCID': 'http://orcid.org/0000-0003-3116-6559', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Javer', 'given': 'Amin', 'sequence': 'additional'}, { 'ORCID': 'http://orcid.org/0000-0002-4646-7488', 'affiliation': [], 'authenticated-orcid': False, 'family': 'Alshahrani', 'given': 'Fatimah S.', 'sequence': 'additional'}], 'container-title': 'BMC Infectious Diseases', 'container-title-short': 'BMC Infect Dis', 'content-domain': {'crossmark-restriction': False, 'domain': ['link.springer.com']}, 'created': {'date-parts': [[2024, 3, 1]], 'date-time': '2024-03-01T10:02:24Z', 'timestamp': 1709287344000}, 'deposited': { 'date-parts': [[2024, 3, 1]], 'date-time': '2024-03-01T10:02:52Z', 'timestamp': 1709287372000}, 'indexed': {'date-parts': [[2024, 3, 2]], 'date-time': '2024-03-02T00:28:52Z', 'timestamp': 1709339332222}, 'is-referenced-by-count': 0, 'issue': '1', 'issued': {'date-parts': [[2024, 3, 1]]}, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2024, 12]]}}, 'language': 'en', 'license': [ { 'URL': 'https://creativecommons.org/licenses/by/4.0', 'content-version': 'tdm', 'delay-in-days': 0, 'start': { 'date-parts': [[2024, 3, 1]], 'date-time': '2024-03-01T00:00:00Z', 'timestamp': 1709251200000}}, { 'URL': 'https://creativecommons.org/licenses/by/4.0', 'content-version': 'vor', 'delay-in-days': 0, 'start': { 'date-parts': [[2024, 3, 1]], 'date-time': '2024-03-01T00:00:00Z', 'timestamp': 1709251200000}}], 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12879-024-09137-y.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s12879-024-09137-y/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12879-024-09137-y.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'member': '297', 'original-title': [], 'prefix': '10.1186', 'published': {'date-parts': [[2024, 3, 1]]}, 'published-online': {'date-parts': [[2024, 3, 1]]}, 'publisher': 'Springer Science and Business Media LLC', 'reference': [ { 'key': '9137_CR1', 'unstructured': 'WHO Director-General’s remarks at the media briefing. on 2019-nCoV on 11 ' 'February 2020 [Internet]. [cited 2022 Oct 1]. Available from: ' 'https://www.who.int/director-general/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020.'}, { 'key': '9137_CR2', 'unstructured': 'COVID-19 Map. - Johns Hopkins Coronavirus Resource Center [Internet]. ' '[cited 2022 Oct 1]. Available from: ' 'https://coronavirus.jhu.edu/map.html.'}, { 'DOI': '10.1016/j.jaut.2020.102433', 'author': 'HA Rothan', 'doi-asserted-by': 'publisher', 'first-page': '102433', 'journal-title': 'J Autoimmun', 'key': '9137_CR3', 'unstructured': 'Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of ' 'coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433.', 'volume': '109', 'year': '2020'}, { 'DOI': '10.1186/s13054-020-03120-0', 'author': 'W Ni', 'doi-asserted-by': 'publisher', 'first-page': '1', 'issue': '1', 'journal-title': 'Crit Care', 'key': '9137_CR4', 'unstructured': 'Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, et al. Role of ' 'angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. ' '2020;24(1):1–10.', 'volume': '24', 'year': '2020'}, { 'DOI': '10.1038/s41586-020-2196-x', 'author': 'R Wölfel', 'doi-asserted-by': 'publisher', 'first-page': '465', 'issue': '7809', 'journal-title': 'Nature', 'key': '9137_CR5', 'unstructured': 'Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. ' 'Virological assessment of hospitalized patients with COVID-2019. Nature. ' '2020;581(7809):465–9.', 'volume': '581', 'year': '2020'}, { 'DOI': '10.1056/NEJMc2001737', 'author': 'L Zou', 'doi-asserted-by': 'publisher', 'first-page': '1177', 'issue': '12', 'journal-title': 'N Engl J Med', 'key': '9137_CR6', 'unstructured': 'Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 ' 'viral load in upper respiratory specimens of infected patients. N Engl J ' 'Med. 2020;382(12):1177–9.', 'volume': '382', 'year': '2020'}, { 'DOI': '10.1017/S0022172400040225', 'author': 'BA Saggers', 'doi-asserted-by': 'publisher', 'first-page': '509', 'issue': '4', 'journal-title': 'Epidemiol Infect', 'key': '9137_CR7', 'unstructured': 'Saggers BA, Stewart GT. Polyvinyl-pyrrolidone-iodine: an assessment of ' 'antibacterial activity. Epidemiol Infect. 1964;62(4):509–18.', 'volume': '62', 'year': '1964'}, { 'author': 'MS Amin', 'first-page': '5', 'issue': '1', 'journal-title': 'Pediatr Dent', 'key': '9137_CR8', 'unstructured': 'Amin MS, Harrison RL, Benton TS, Roberts M, Weinstein P. Effect of ' 'povidone-iodine on Streptococcus mutans in children with extensive ' 'dental caries. Pediatr Dent. 2004;26(1):5–10.', 'volume': '26', 'year': '2004'}, { 'DOI': '10.4103/SJOH.SJOH_36_20', 'doi-asserted-by': 'crossref', 'key': '9137_CR9', 'unstructured': 'Farahat M, Mesallam T, Alrasheed A, Malki K. Validity and reliability of ' 'the arabic version of the wisconsin upper respiratory symptom survey ' '(AWURSS-11). Saudi Journal of Otorhinolaryngology Head and Neck Surgery ' '[Internet]. 2021;23(1):26–30. Available from: ' 'https://www.sjohns.org/article.asp?issn=1319-8491.'}, { 'DOI': '10.5144/0256-4947.2018.22', 'author': 'F Alanazy', 'doi-asserted-by': 'publisher', 'first-page': '22', 'issue': '1', 'journal-title': 'Ann Saudi Med', 'key': '9137_CR10', 'unstructured': 'Alanazy F, Al Dousary S, Albosaily A, Aldriweesh T, Alsaleh S, Aldrees ' 'T. Psychometric arabic sino-nasal outcome Test-22: validation and ' 'translation in chronic rhinosinusitis patients. Ann Saudi Med. ' '2018;38(1):22–7.', 'volume': '38', 'year': '2018'}, { 'DOI': '10.1042/CS20050086', 'author': 'SA Bustin', 'doi-asserted-by': 'publisher', 'first-page': '365', 'issue': '4', 'journal-title': 'Clin Sci', 'key': '9137_CR11', 'unstructured': 'Bustin SA, Mueller R. Real-time reverse transcription PCR (qRT-PCR) and ' 'its potential use in clinical diagnosis. Clin Sci. 2005;109(4):365–79.', 'volume': '109', 'year': '2005'}, { 'DOI': '10.1002/pst.185', 'author': 'SA Julious', 'doi-asserted-by': 'publisher', 'first-page': '287', 'issue': '4', 'journal-title': 'Pharm Statistics: J Appl Stat Pharm Ind', 'key': '9137_CR12', 'unstructured': 'Julious SA. Sample size of 12 per group rule of thumb for a pilot study. ' 'Pharm Statistics: J Appl Stat Pharm Ind. 2005;4(4):287–91.', 'volume': '4', 'year': '2005'}, { 'DOI': '10.7326/0003-4819-134-8-200104170-00011', 'author': 'D Moher', 'doi-asserted-by': 'publisher', 'first-page': '657', 'issue': '8', 'journal-title': 'Ann Intern Med', 'key': '9137_CR13', 'unstructured': 'Moher D, Schulz KF, Altman DG, Group* C. The CONSORT statement: revised ' 'recommendations for improving the quality of reports of parallel-group ' 'randomized trials. Ann Intern Med. 2001;134(8):657–62.', 'volume': '134', 'year': '2001'}, { 'DOI': '10.3390/ijerph191912148', 'author': 'M Idrees', 'doi-asserted-by': 'publisher', 'first-page': '12148', 'issue': '19', 'journal-title': 'Int J Environ Res Public Health', 'key': '9137_CR14', 'unstructured': 'Idrees M, McGowan B, Fawzy A, Abuderman AA, Balasubramaniam R, Kujan O. ' 'Efficacy of Mouth rinses and nasal spray in the inactivation of ' 'SARS-CoV-2: a systematic review and Meta-analysis of in Vitro and in ' 'vivo studies. Int J Environ Res Public Health. 2022;19(19):12148.', 'volume': '19', 'year': '2022'}, { 'DOI': '10.1177/0145561320957237', 'author': 'JS Pelletier', 'doi-asserted-by': 'publisher', 'first-page': '192S', 'issue': '2suppl', 'journal-title': 'Ear Nose Throat J', 'key': '9137_CR15', 'unstructured': 'Pelletier JS, Tessema B, Frank S, Westover JB, Brown SM, Capriotti JA. ' 'Efficacy of povidone-iodine nasal and oral antiseptic preparations ' 'against severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). ' 'Ear Nose Throat J. 2021;100(2suppl):192S–6.', 'volume': '100', 'year': '2021'}, { 'DOI': '10.1001/jamaoto.2020.3053', 'author': 'S Frank', 'doi-asserted-by': 'publisher', 'first-page': '1054', 'issue': '11', 'journal-title': 'JAMA Otolaryngology–Head Neck Surg', 'key': '9137_CR16', 'unstructured': 'Frank S, Brown SM, Capriotti JA, Westover JB, Pelletier JS, Tessema B. ' 'In vitro efficacy of a povidone-iodine nasal antiseptic for rapid ' 'inactivation of SARS-CoV-2. JAMA Otolaryngology–Head Neck Surg. ' '2020;146(11):1054–8.', 'volume': '146', 'year': '2020'}, { 'DOI': '10.1101/2020.05.18.103184', 'doi-asserted-by': 'crossref', 'key': '9137_CR17', 'unstructured': 'Liang B, Yuan X, Wei G, Wang W, Zhang M, Peng H et al. In-vivo toxicity ' 'studies and in-vitro inactivation of SARS-CoV-2 by povidone-iodine ' 'in-situ gel forming formulations. BioRxiv. 2020.'}, { 'DOI': '10.1177/0145561320932318', 'author': 'S Frank', 'doi-asserted-by': 'publisher', 'first-page': '586', 'issue': '9', 'journal-title': 'Ear Nose Throat J', 'key': '9137_CR18', 'unstructured': 'Frank S, Capriotti J, Brown SM, Tessema B. Povidone-iodine use in ' 'sinonasal and oral cavities: a review of safety in the COVID-19 era. Ear ' 'Nose Throat J. 2020;99(9):586–93.', 'volume': '99', 'year': '2020'}, { 'DOI': '10.1007/s15010-020-01563-9', 'author': 'CJ Seneviratne', 'doi-asserted-by': 'publisher', 'first-page': '305', 'issue': '2', 'journal-title': 'Infection', 'key': '9137_CR19', 'unstructured': 'Seneviratne CJ, Balan P, Ko KKK, Udawatte NS, Lai D, Ng DHL, et al. ' 'Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: ' 'randomized control trial in Singapore. Infection. 2021;49(2):305–11.', 'volume': '49', 'year': '2021'}, { 'DOI': '10.1097/MD.0000000000028925', 'doi-asserted-by': 'crossref', 'key': '9137_CR20', 'unstructured': 'Natto ZS, Bakhrebah MA, Afeef M, Al-Harbi S, Nassar MS, Alhetheel AF et ' 'al. The short-term effect of different chlorhexidine forms versus ' 'povidone iodine mouth rinse in minimizing the oral SARS-CoV-2 viral ' 'load: an open label randomized controlled clinical trial study. ' 'Medicine. 2022;101(30).'}, { 'DOI': '10.1016/j.amjoto.2022.103549', 'author': 'PJ Fantozzi', 'doi-asserted-by': 'publisher', 'first-page': '103549', 'issue': '6', 'journal-title': 'Am J Otolaryngol', 'key': '9137_CR21', 'unstructured': 'Fantozzi PJ, Pampena E, Pierangeli A, Oliveto G, Sorrentino L, di Vanna ' 'D, et al. Efficacy of antiseptic mouthrinses against SARS-CoV-2: a ' 'prospective randomized placebo-controlled pilot study. Am J Otolaryngol. ' '2022;43(6):103549.', 'volume': '43', 'year': '2022'}, { 'DOI': '10.1016/j.jebdp.2021.101584', 'author': 'R Elzein', 'doi-asserted-by': 'publisher', 'first-page': '101584', 'issue': '3', 'journal-title': 'J Evid Based Dent Pract', 'key': '9137_CR22', 'unstructured': 'Elzein R, Abdel-Sater F, Fakhreddine S, Abi Hanna P, Feghali R, Hamad H, ' 'et al. In vivo evaluation of the virucidal efficacy of chlorhexidine and ' 'povidone-iodine mouthwashes against salivary SARS-CoV-2. A ' 'randomized-controlled clinical trial. J Evid Based Dent Pract. ' '2021;21(3):101584.', 'volume': '21', 'year': '2021'}, { 'DOI': '10.1016/j.adaj.2021.05.021', 'author': 'P Chaudhary', 'doi-asserted-by': 'publisher', 'first-page': '903', 'issue': '11', 'journal-title': 'J Am Dent Association', 'key': '9137_CR23', 'unstructured': 'Chaudhary P, Melkonyan A, Meethil A, Saraswat S, Hall DL, Cottle J, et ' 'al. Estimating salivary carriage of severe acute respiratory syndrome ' 'coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in ' 'reducing viral load: a randomized controlled trial. J Am Dent ' 'Association. 2021;152(11):903–8.', 'volume': '152', 'year': '2021'}, { 'DOI': '10.1186/s13063-020-04963-2', 'author': 'MJ Hasan', 'doi-asserted-by': 'publisher', 'first-page': '1', 'issue': '1', 'journal-title': 'Trials', 'key': '9137_CR24', 'unstructured': 'Hasan MJ, Rumi SK, Banu SS, Uddin AKM, Islam MS, Arefin MK. Virucidal ' 'effect of povidone iodine on COVID-19 in the nasopharynx: a structured ' 'summary of a study protocol for an open-label randomized clinical trial. ' 'Trials. 2021;22(1):1–2.', 'volume': '22', 'year': '2021'}, { 'DOI': '10.1002/lary.29935', 'author': 'D Zarabanda', 'doi-asserted-by': 'publisher', 'first-page': '2089', 'issue': '11', 'journal-title': 'Laryngoscope', 'key': '9137_CR25', 'unstructured': 'Zarabanda D, Vukkadala N, Phillips KM, Qian ZJ, Mfuh KO, Hatter MJ, et ' 'al. The Effect of Povidone-Iodine nasal spray on nasopharyngeal ' 'SARS‐CoV‐2 viral load: a Randomized Control Trial. Laryngoscope. ' '2022;132(11):2089–95. https://doi.org/10.1002/lary.29935', 'volume': '132', 'year': '2022'}, { 'DOI': '10.1007/s40121-020-00324-3', 'author': 'SN Rao', 'doi-asserted-by': 'publisher', 'first-page': '573', 'issue': '3', 'journal-title': 'Infect Dis Ther', 'key': '9137_CR26', 'unstructured': 'Rao SN, Manissero D, Steele VR, Pareja J. A systematic review of the ' 'clinical utility of cycle threshold values in the context of COVID-19. ' 'Infect Dis Ther. 2020;9(3):573–86.', 'volume': '9', 'year': '2020'}, { 'DOI': '10.3390/v13091882', 'author': 'E Domingo', 'doi-asserted-by': 'publisher', 'first-page': '1882', 'issue': '9', 'journal-title': 'Viruses', 'key': '9137_CR27', 'unstructured': 'Domingo E, García-Crespo C, Lobo-Vega R, Perales C. Mutation rates, ' 'mutation frequencies, and proofreading-repair activities in RNA virus ' 'genetics. Viruses. 2021;13(9):1882.', 'volume': '13', 'year': '2021'}, { 'author': 'M Eggers', 'first-page': '249', 'issue': '2', 'journal-title': 'Infect DisTher', 'key': '9137_CR28', 'unstructured': 'Eggers M, Koburger 一 Janssen T, Eickmann M, et al. H Diro bactericidal ' 'and virucidal efficacy of povidone 一 iodine ' 'gargle/mouthwashagainstrespiratoryand oraltract pathogens J. Infect ' 'DisTher. 2018;7(2):249–59.', 'volume': '7', 'year': '2018'}, { 'DOI': '10.1210/jcem-66-3-632', 'author': 'ADERAW PAUL', 'doi-asserted-by': 'publisher', 'first-page': '632', 'issue': '3', 'journal-title': 'J Clin Endocrinol Metab', 'key': '9137_CR29', 'unstructured': 'Paul Aderaw, Reinhardt TL, Safran W, Pino M, McARTHUR Sam. Effect of ' 'mouth rinsing with two polyvinylpyrrolidone-iodine mixtures on iodine ' 'absorption and thyroid function. J Clin Endocrinol Metab. ' '1988;66(3):632–5.', 'volume': '66', 'year': '1988'}, { 'DOI': '10.1001/jamaoto.2020.5490', 'author': 'J Guenezan', 'doi-asserted-by': 'publisher', 'first-page': '400', 'issue': '4', 'journal-title': 'JAMA Otolaryngology–Head Neck Surg', 'key': '9137_CR30', 'unstructured': 'Guenezan J, Garcia M, Strasters D, Jousselin C, Lévêque N, Frasca D, et ' 'al. Povidone iodine mouthwash, gargle, and nasal spray to reduce ' 'nasopharyngeal viral load in patients with COVID-19: a randomized ' 'clinical trial. JAMA Otolaryngology–Head Neck Surg. 2021;147(4):400–1.', 'volume': '147', 'year': '2021'}, { 'DOI': '10.1016/j.ijom.2010.09.012', 'author': 'G Arakeri', 'doi-asserted-by': 'publisher', 'first-page': '173', 'issue': '2', 'journal-title': 'Int J Oral Maxillofac Surg', 'key': '9137_CR31', 'unstructured': 'Arakeri G, Brennan PA. Povidone-iodine: an anti-oedematous agent? Int J ' 'Oral Maxillofac Surg. 2011;40(2):173–6.', 'volume': '40', 'year': '2011'}, { 'DOI': '10.1002/lary.29818', 'author': 'P Wu', 'doi-asserted-by': 'publisher', 'first-page': '1148', 'issue': '6', 'journal-title': 'Laryngoscope', 'key': '9137_CR32', 'unstructured': 'Wu P, Cheng P, Chang C, Lo W, Cheng P. Efficacy of povidone-iodine nasal ' 'irrigation solution after sinonasal surgery: a randomized controlled ' 'study. Laryngoscope. 2022;132(6):1148–52.', 'volume': '132', 'year': '2022'}, { 'DOI': '10.1016/j.amjoto.2020.102604', 'author': 'VS Lee', 'doi-asserted-by': 'publisher', 'first-page': '102604', 'issue': '5', 'journal-title': 'Am J Otolaryngol', 'key': '9137_CR33', 'unstructured': 'Lee VS, Pottinger PS, Davis GE. Tolerability and effectiveness of ' 'povidone-iodine or mupirocin versus saline sinus irrigations for chronic ' 'rhinosinusitis. Am J Otolaryngol. 2020;41(5):102604.', 'volume': '41', 'year': '2020'}, { 'DOI': '10.3390/vaccines9090989', 'author': 'YJ Fan', 'doi-asserted-by': 'publisher', 'first-page': '989', 'issue': '9', 'journal-title': 'Vaccines (Basel)', 'key': '9137_CR34', 'unstructured': 'Fan YJ, Chan KH, Hung IFN. Safety and efficacy of COVID-19 vaccines: a ' 'systematic review and meta-analysis of different vaccines at phase 3. ' 'Vaccines (Basel). 2021;9(9):989.', 'volume': '9', 'year': '2021'}, { 'DOI': '10.1016/S1473-3099(20)30237-1', 'author': 'GM Joynt', 'doi-asserted-by': 'publisher', 'first-page': '635', 'issue': '6', 'journal-title': 'Lancet Infect Dis', 'key': '9137_CR35', 'unstructured': 'Joynt GM, Wu WKK, Understanding. COVID-19: what does viral RNA load ' 'really mean? Lancet Infect Dis. 2020;20(6):635–6.', 'volume': '20', 'year': '2020'}, { 'DOI': '10.1001/jamanetworkopen.2022.35837', 'doi-asserted-by': 'publisher', 'key': '9137_CR36', 'unstructured': 'Levy AG, Thorpe A, Scherer LD, Scherer AM, Drews FA, Butler JM et al. ' 'Misrepresentation and Nonadherence Regarding COVID-19 Public Health ' 'Measures. JAMA Netw Open [Internet]. 2022;5(10):e2235837–e2235837. ' 'https://doi.org/10.1001/jamanetworkopen.2022.35837.'}], 'reference-count': 36, 'references-count': 36, 'relation': {}, 'resource': { 'primary': { 'URL': 'https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09137-y'}}, 'score': 1, 'short-title': [], 'source': 'Crossref', 'subject': ['Infectious Diseases'], 'subtitle': [], 'title': 'Efficacy of povidone-iodine nasal rinse and mouth wash in COVID-19 management: a prospective, ' 'randomized pilot clinical trial (povidone-iodine in COVID-19 management)', 'type': 'journal-article', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'volume': '24'}