Evaluation of the Efficacy of Mouth Rinses With Commercial Mouthwashes to Decrease Viral Load in Saliva in COVID-19 Patients

Mira et al., NCT05543603, NCT05543603, Jan 2022

Chlorhexidine

52nd treatment shown to reduce risk in November 2023, now with p < 0.00000000001 from 5 studies.

Lower risk for progression, cases, and viral clearance.

No treatment is 100% effective. Protocols combine treatments.

6,300+ studies for 210+ treatments. c19early.org

Meta Analysis

48 patient chlorhexidine early treatment RCT with results not reported over 3 years after completion.

3 chlorhexidine RCTs have results missing long after expected1-3
The trials report a total of 383 patients, with 2 trials having actual enrollment of 293, and the other estimated.

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 Tarragó-Gil, Alemany 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 that can differentiate intact vs. degraded virus are preferred.

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1. Keating et al., SHIELD Study: Using Naso-oropharyngeal Antiseptic Decolonization to Reduce COVID-19 Viral Shedding (SHIELD), NCT04478019, clinicaltrials.gov/study/NCT04478019clinicaltrials.gov.

2. Xie et al., Oral Rinse to Reduced Expelled Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) During COVID-19 Infection, NCT04931004, clinicaltrials.gov/study/NCT04931004clinicaltrials.gov.

3. Mira et al., Evaluation of the Efficacy of Mouth Rinses With Commercial Mouthwashes to Decrease Viral Load in Saliva in COVID-19 Patients, NCT05543603, clinicaltrials.gov/study/NCT05543603clinicaltrials.gov.

4. Tarragó-Gil et al., Randomized clinical trial to assess the impact of oral intervention with cetylpyridinium chloride to reduce salivary SARS‐CoV‐2 viral load, Journal of Clinical Periodontology, doi:10.1111/jcpe.13746.wiley.com, doi.org.

5. Alemany et al., Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial, Journal of Dental Research, doi:10.1177/00220345221102310.sagepub.com, doi.org.

Mira et al., 8 Jan 2022, Double Blind Randomized Controlled Trial, placebo-controlled, trial NCT05543603 (history).