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Use of chlorhexidine to eradicate oropharyngeal SARS‐CoV‐2 in COVID‐19 patients

Huang et al., Journal of Medical Virology, doi:10.1002/jmv.26954
Apr 2021  
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Viral clearance, spray and.. 85% Improvement Relative Risk Viral clearance, rinse only 60% Chlorhexidine  Huang et al.  LATE TREATMENT  RCT Is late treatment with chlorhexidine beneficial for COVID-19? RCT 173 patients in the USA (May - December 2020) Improved viral clearance with chlorhexidine (p<0.000001) Huang et al., J. Medical Virology, Apr 2021 Favorschlorhexidine Favorscontrol 0 0.5 1 1.5 2+
45th treatment shown to reduce risk in January 2024
*, now with p = 0.00000000062 from 3 studies.
Lower risk for progression, cases, and viral clearance.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 81 treatments.
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:
This PaperChlorhexidineAll
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.
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Late treatment
is less effective
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