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0 0.5 1 1.5 2+ Viral load, 60 min 72% Improvement Relative Risk Viral load, 30 min 77% Viral load, immediately 73% Hydrogen Peroxide  Bezinelli et al.  INTUBATED PATIENTS  DB RCT Does very late treatment with hydrogen peroxide + chlorhexidine reduce short-term viral load? Double-blind RCT 48 patients in Brazil (May - July 2020) Improved viral clearance with hydrogen peroxide + chlorhexidine (not stat. sig., p=0.49) Bezinelli et al., J. Oral Microbiology, Dec 2022 Favors hydrogen peroxide Favors control

Antimicrobial oral lavage reduces the SARS-CoV-2 load in intubated patients: randomized clinical trial

Bezinelli et al., Journal of Oral Microbiology, doi:10.1080/20002297.2022.2152179, NCT04537962
Dec 2022  
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RCT 24 intubated patients treated with hydrogen peroxide + chlorhexidine oral rinse, and 19 with chlorhexidine, showing viral load reductions immediately after and 30/60 minutes later, with statistical significance only for immediate reduction with hydrogen peroxide + chlorhexidine.
Analysis of short-term changes in viral load using PCR may not detect effective treatments because PCR is unable to differentiate between intact infectious virus and non-infectious or destroyed virus particles. For example Alemany, Tarragó‐Gil perform RCTs with cetylpyridinium chloride (CPC) mouthwash that show no difference in PCR viral load, however there was significantly increased detection of SARS-CoV-2 nucleocapsid protein, indicating viral lysis. CPC inactivates SARS-CoV-2 by degrading its membrane, exposing the nucleocapsid of the virus. To better estimate changes in viral load and infectivity, methods like viral culture or antigen detection that can differentiate intact vs. degraded virus are preferred.
This study is excluded in meta analysis: study only provides PCR-based short-term viral load results.
viral load, 72.3% lower, relative load 0.28, p = 0.49, treatment 24, control 24, 60 min.
viral load, 76.6% lower, relative load 0.23, p = 0.12, treatment 24, control 24, 30 min.
viral load, 73.2% lower, relative load 0.27, p = 0.02, treatment 24, control 24, immediately.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bezinelli et al., 13 Dec 2022, Double Blind Randomized Controlled Trial, Brazil, peer-reviewed, 9 authors, study period May 2020 - July 2020, this trial uses multiple treatments in the treatment arm (combined with chlorhexidine) - results of individual treatments may vary, trial NCT04537962 (history).
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Antimicrobial oral lavage reduces the SARS-CoV-2 load in intubated patients: randomized clinical trial
Letícia Mello Bezinelli, Luciana Corrêa, Stephany Beyerstedt, Érika Bevilaqua Rangel, Carlos Benitez, Nelson Hamerschlak, João Renato Rebello Pinho, Debora Heller, Fernanda De Paula Eduardo
Journal of Oral Microbiology, doi:10.1080/20002297.2022.2152179
Background: The oral cavity can be a reservoir for SARS-CoV-2 and may play a crucial role in the viral transmission in the hospital environment. Objective: To investigate whether an oral hygiene protocol with chlorhexidine (CHX) used alone and in combination with hydrogen peroxide (HP) in the intensive care unit was effective in reducing the SARS-CoV-2 viral load in the oral cavity. Methods: SARS-CoV-2 viral load was measured on oral fluid samples collected from patients undergoing orotracheal intubation. The study sample was randomly in: CHX group (n = 19)oral rinse using only 0.12% CHX solution; HP+CHX group (n = 24) -oral rinse with 1.5% HP and 0.12% CHX. The samples were collected before the interventions (T0), immediately (T1), 30 minutes (T2) and 60 minutes (T3) after the procedure. Results: A significant viral load reduction was observed at T1 (mean ± SD:-0.57 ± 0.19 log10;-73.2%;p = 0.022) in the HP+CHX group. No statistically significant differences between any time points were observed in the CHX group. Conclusion: The HP+CHX oral rinses significantly reduced the SARS-CoV-2 viral load in the oral fluid immediately after the procedure. The CHX oral rinse alone did not result in any significant viral load reductions.
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Late treatment
is less effective
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