Repurposing povidone-iodine to reduce the risk of SARS-CoV-2 infection and transmission: a narrative review
Nicole-Ann Lim, Ooiean Teng, Chester Yan Hao Ng, Lena X Y Bao, Paul Anantharajah Tambyah, Amy M L Quek, Raymond C S Seet
Annals of Medicine, doi:10.1080/07853890.2022.2076902
Background: Accumulating data suggest antiviral effects of povidone-iodine against the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This narrative review aims to examine the antiviral mechanisms of povidone-iodine, efficacy of povidone-iodine against the SARS-CoV-2 virus, and safety of povidone-iodine to human epithelial cells and thyroid function. Methods: We searched the electronic databases PubMed, Embase, Cochrane Library, ClinicalTrials.gov and World Health Organization's International Clinical Trials Registry Platform for articles containing the keywords "povidone-iodine", "SARS-CoV-2" and "COVID-19" from database inception till 3 June 2021. Results: Despite in vitro data supporting the anti-SARS-CoV-2 effects of povidone-iodine, findings from clinical studies revealed differences in treatment response depending on study settings (healthy vs. hospitalized individuals), treatment target (nasal vs. oral vs. pharynx), method of administration (oral rinse vs. gargle vs. throat spray) and choice of samples used to measure study endpoints (nasopharyngeal vs. saliva). One large-scale clinical trial demonstrated reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak. Povidone-iodine is also used to disinfect the oro-pharyngeal space prior to dental or otolaryngology procedures. Although existing data suggest minimal impact of povidone-iodine on thyroid function, high-quality safety data are presently lacking. Conclusions: Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.
KEY MESSAGES Accumulating data suggest antiviral effects of povidone-iodine against the SARS-CoV-2 virus. Findings from clinical studies reveal differences in treatment response depending on study settings, treatment target, method of administration and choice of samples used to measure study endpoints. One large-scale clinical trial observed reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak. Povidone-iodine application to the oropharyngeal space could complement existing nonpharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.
Author contributions NAL contributed to the conception of the work, acquisition and interpretation of data, as well as the drafting and revision of the manuscript. OT contributed to the conception of the work, acquisition and interpretation of data, as well as the drafting and revision of the manuscript. RS contributed to the conception of the work, acquisition and interpretation of data, as well as the drafting and revision of the manuscript. LB contributed to the conception of the work, acquisition and interpretation of data. CN contributed to the conception of the work, acquisition and interpretation of data. AQ contributed to the conception of the work, and the drafting and revision of the manuscript. PT contributed to the conception of the work, and the drafting and revision of the manuscript. All authors read and approved the final manuscript.
Disclosure statement Dr Seet reported receiving research grants from the National Medical Research Council and Temasek Foundation, Singapore.
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