Efficacy of antiseptic mouthrinses against SARS-CoV-2: A prospective randomized placebo-controlled pilot study
American Journal of Otolaryngology, doi:10.1016/j.amjoto.2022.103549
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
When all antiseptic mouthrinses were considered, PVP-I 1% was found to be more effective in reducing the Ct Values at T1 compared to CHX 0.12% (p=0.001), the H 2 O 2 1% (p=0.027) and the placebo (p=0.001). In addition, PVP-I 1% was found to be more effective in terms of viral load reduction both at T1 (p=0.03) and at T2 (p=0.024) when compared to the placebo. No other statistically significant differences were found amongst the other rinses (Table 3 ). Interestingly, when all the negative patients were considered (at T1 and T2), the median SARS-CoV-2 viral load was 21.5 copies/mL (IQR: 4.9 -294.5), and the median Ct value was 37.8 (IQR: 34.1 -39.8).
J o u r n a l P r e -p r o o f
Discussion This single-blinded randomized controlled pilot study reported on the efficacy of three oral antiseptics on the reduction of oral SARS-CoV-2 viral load in the oral and oropharyngeal region. PVP-I 1% had the highest efficacy with five patients (62.5%) at T1 and three patients (37.5%) at T2 having undetectable SARS-CoV-2 viral load after the rinse, with an overall median viral load reduction of 19.4 (IQR: 67.3 -8.2) viral loads/mL at T1 (p=0.26), and 33.2 (IQR: 77.6 -5.4) viral loads/mL at T2 (p=0.42). The median Ct value in the PVP-I 1% group at T0 was 36.3 (IQR: 32.0 -38.5), followed by 40.0 (IQR: 29.8 -40.0) at T1 (p=0.002), and 38.8 (IQR: 30.9 -40.0) at T2 (p=0.09). H 2 O 2 1% showed the second highest efficacy, with six patients (54.5%) at T1, and eight patients (72.7%) at T2..
Bidra, Pelletier, Westover, Frank, Brown et al., Comparison of In Vitro Inactivation of SARS CoV-2 with Hydrogen Peroxide and Povidone-Iodine Oral Antiseptic Rinses, J Prosthodont, doi:10.1111/jopr.13220
Carrouel, Gonçalves, Conte, Antiviral Activity of Reagents in Mouth Rinses against SARS-CoV
Chaudhary, Melkonyan, Meethil, 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 Assoc, doi:10.1016/j.adaj.2021.05.021
Elzein, Sater, Fakhreddine, 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, doi:10.1016/j.jebdp.2021
Escandón, Rasmussen, Bogoch, COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection, BMC Infect Dis, doi:10.1186/s12879-021-06357-4
Ferrer, Barrueco, Martinez-Beneyto, Clinical evaluation of antiseptic mouth rinses to reduce salivary load of SARS-CoV-2, Sci Rep, doi:10.1038/s41598-021-03461-y
Goralnick, Kaufmann, Gawande, Mass-Vaccination Sites -An Essential Innovation to Curb the Covid-19 Pandemic, N Engl J Med, doi:10.1056/NEJMp2102535
Gottsauner, Michaelides, Schmidt, A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2, Clin Oral Investig, doi:10.1007/s00784-020-03549-1
Huang, Huang, Use of chlorhexidine to eradicate oropharyngeal SARS-CoV-2 in COVID-19 patients, J Med Virol, doi:10.1002/jmv.26954
Komine, Yamaguchi, Okamoto, Yamamoto, Virucidal activity of oral care products against SARS-CoV-2 in vitro, J Oral Maxillofac Surgery, doi:10.1016/j.ajoms.2021
Kowalski, Sanabria, Ridge, COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice, Head Neck, doi:10.1002/hed.26164
Lamas, Dios, Rodríguez, Is povidone iodine mouthwash effective against SARS-CoV-2? First in vivo tests, Oral Dis, doi:10.1111/odi.13526
Li, Campbell, Kulkarni, The temporal association of introducing and lifting non-pharmaceutical interventions with the time-varying reproduction number (<em>R</em>) of SARS-CoV-2: a modelling study across 131 countries, Lancet Infect Dis, doi:10.1016/S1473-3099(20)30785-4
Meister, Brüggemann, Todt, Virucidal Efficacy of Different Oral Rinses Against Severe Acute Respiratory Syndrome Coronavirus 2, J Infect Dis, doi:10.1093/infdis/jiaa471
Muñoz-Basagoiti, Perez-Zsolt, León, CoV-J o u r n a l P r e -p r o o f Journal Pre-proof
Seneviratne, Balan, Ko, Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore, Infection, doi:10.1007/s15010-020-01563-9
To, Tsang, Yip, Consistent Detection of 2019 Novel Coronavirus in Saliva. Clin Infect J o u r n a l P r e -p r o o f Journal Pre-proof Dis an Off, Publ Infect Dis Soc Am, doi:10.1093/cid/ciaa149
Xu, Zhong, Deng, High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa, Int J Oral Sci, doi:10.1038/s41368-020-0074-x