RCT 294 hospitalized patients in the USA, showing faster oropharyngeal viral clearance with chlorhexidine. Results were better with a combination of oropharyngeal rinse and posterior oropharyngeal spray compared with the rinse alone.
Targeted administration to the respiratory tract provides treatment directly
to the typical source of initial SARS-CoV-2 infection and replication, and
allows for rapid onset of action, higher local drug concentration, and reduced
systemic side effects (early treatment may be more beneficial).
risk of no viral clearance, 85.1% lower, RR 0.15, p < 0.001, treatment 13 of 93 (14.0%), control 75 of 80 (93.8%), NNT 1.3, oropharyngeal rinse and spray, day 4.
|
risk of no viral clearance, 59.9% lower, RR 0.40, p < 0.001, treatment 25 of 66 (37.9%), control 52 of 55 (94.5%), NNT 1.8, oropharyngeal rinse only, day 4.
|
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
|
Huang et al., 30 Apr 2021, Randomized Controlled Trial, USA, peer-reviewed, median age 62.0, 2 authors, study period 20 May, 2020 - 15 December, 2020.
Contact:
drjhuang@gmail.com.
Use of chlorhexidine to eradicate oropharyngeal SARS‐CoV‐2 in COVID‐19 patients
Y Hanna Huang, MD Jong T Huang
Journal of Medical Virology, doi:10.1002/jmv.26954
As public distribution of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is underway, prevention of coronavirus disease 2019 (COVID-19) relies on minimizing spread. In this study, chlorhexidine gluconate was investigated as a topical antimicrobial agent against SARS-CoV-2. This was a randomized, prospective cohort study using chlorhexidine as an oral rinse and posterior oropharyngeal spray in hospitalized COVID-19 patients. The primary outcome was presence or absence of laboratory-confirmed SARS-CoV-2 in the oral and oropharyngeal cavities after 4 days of chlorhexidine use and standard of care (study group) or standard of care only (control group). SARS-CoV-2 was eliminated from the oropharynx in 62.1% of patients who used chlorhexidine as an oral rinse, versus 5.5% of the control group patients. Among patients who used a combination of oral rinse and oropharyngeal spray, 86.0% eliminated oropharyngeal SARS-CoV-2, versus 6.3% of control patients. Chlorhexidine is a simple and safe addition to current COVID-19 prevention guidelines and may play a significant role in reducing disease spread.
CONFLICT OF INTERESTS The authors declare that there are no conflict of interests.
References
Anderson, Podgorny, Berríos-Torres, Strategies to prevent surgical site infections in acute care hospitals: 2014 update, Infect Control Hosp Epidemiol
Denton, Chlorhexidine, Disinfection, Sterilization and Preservation
Dhand, Li, Coughs and sneezes: their role in transmission of respiratory viral infections, including SARS-CoV-2, Am J Respir Crit Care Med
Firestone, Lorentz, Wang, First identified cases of SARS-CoV-2 variant B.1.1.7 in Minnesota -December 2020-January 2021, Morb Mortal Wkly Rep
Houston, Hougland, Anderson, Larocco, Kennedy et al., Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery, Am J Crit Care
Jones, Chlorhexidine: is it still the gold standard?, Periodontol
Khokhar, Roy, Purohit, Goyal, Setia, Viricidal treatments for prevention of coronavirus infection, Pathog Glob Health
Liu, Yan, Wan, Viral dynamics in mild and severe cases of COVID-19, Lancet Infect Dis
Meyers, Robison, Milici, Lowering the transmission and spread of human coronavirus, J Med Virol
Yoon, Yoon, Song, Clinical significance of a high SARS-CoV-2 viral load in the saliva, J Korean Med Sci