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All Studies   Meta Analysis       

The short-term effect of different chlorhexidine forms versus povidone iodine mouth rinse in minimizing the oral SARS-CoV-2 viral load: An open label randomized controlled clinical trial study

Jul 2022  
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Viral load, combined 74% Improvement Relative Risk Viral load, E 96% Viral load, S 44% Povidone-Iodine  Natto et al.  EARLY TREATMENT  RCT Does povidone-iodine reduce short-term viral load for COVID-19? RCT 24 patients in Saudi Arabia (June - July 2021) Trial compares with saline, results vs. placebo may differ Improved viral load with povidone-iodine (not stat. sig., p=0.27) c19early.org Natto et al., Medicine, July 2022 Favorspovidone-iodine Favorssaline 0 0.5 1 1.5 2+
PVP-I for COVID-19
13th treatment shown to reduce risk in February 2021, now with p = 0.000000004 from 21 studies.
Lower risk for mortality, cases, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 111 treatments. c19early.org
60 patient RCT comparing chlorhexidine, PVP-I, and saline in Saudi Arabia with a single mouth rinse treatment and PCR testing 5 minutes later, showing statistically significant improvement in Ct value for PVP-I. PVP-I showed greater improvement than saline, without statistical significance.
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.
This study is excluded in the after exclusion results of meta analysis: study only provides short-term viral load results.
Study covers chlorhexidine and povidone-iodine.
risk of viral load, 73.6% lower, RR 0.26, p = 0.27, treatment 12, control 12, relative improvement in Ct value, both genes combined.
risk of viral load, 96.2% lower, RR 0.04, p = 0.12, treatment mean 4.43 (±4.78) n=12, control mean 0.17 (±7.67) n=12, relative improvement in Ct value, E gene.
risk of viral load, 44.4% lower, RR 0.56, p = 0.60, treatment mean 3.33 (±5.6) n=12, control mean 1.85 (±7.68) n=12, relative improvement in Ct value, S gene.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Natto et al., 29 Jul 2022, Randomized Controlled Trial, Saudi Arabia, peer-reviewed, 7 authors, study period June 2021 - July 2021, this trial compares with another treatment - results may be better when compared to placebo, trial NCT04941131 (history).
This PaperPovidone-Iod..All
The short-term effect of different chlorhexidine forms versus povidone iodine mouth rinse in minimizing the oral SARS-CoV-2 viral load: An open label randomized controlled clinical trial study
DrPH Zuhair S Natto, PhD Muhammed A Bakhrebah, MSc Marwah Afeef, BA Samiah Al-Harbi, PhD Majed S Nassar, PhD Abdulkarim F Alhetheel, PhD Heba Ashi
Medicine, doi:10.1097/md.0000000000028925
Several investigations evaluated the possibility of different types of mouth wash rinse in minimizing the SARS-CoV-2 load. However, results still controversial. The study aim is to assess the short-term efficiency of several over-the-counter mouth rinses and lozenges in minimizing the salivary viral load for SARS-CoV-2 in patients with confirmed COVID-19 in comparison to saline. This is a randomized controlled clinical trial with 4 arms. The recruited cases were randomized using a simple randomization technique and were assigned to chlorhexidine digluconate mouth rinse (CHX mouth rinse), 2 mg of chlorhexidine digluconate lozenges (CHX lozenges), povidone iodine mouth rinse (PVP-I mouth rinse) or saline as a control group. Saliva were collected from all study subjects by passive drool technique at two time points. First, prior to intervention with mouth rinse or the lozenges, the baseline saliva sample was collected. Second saliva samples were collected immediately after the mouth rinse. Real time PCR was conducted and the value threshold cycle (Ct) for each sample was recorded. Majority of the participants had an education level of high school or less (60%), were married (68.3), males (58.3%), and nonsmokers (58.5%). No statistically significant differences between groups at the two times test (P > .05). However, a significant decrease of salivary viral load in all four groups combined (P-value for E genes = .027, and for S genes = .006), and in PVP-I mouth rinse specifically (P = .003 and P = .045, respectively). Povidone iodine mouth rinse showed a potential influence on the reduction of the viral load on a short-term basis. However, longer-term studies of the effect of these products should be conducted. Abbreviations: CHX mouth rinse = digluconate mouth rinse, CHX lozenges = chlorhexidine digluconate lozenges, PVP-I mouth rinse = povidone iodine mouth rinse, Ct = threshold cycle, SARS-CoV-2 = Severe Acute Respiratory Syndrome Coronavirus 2, KFGH = King Fahad General Hospital, RT-PCR = Real-time polymerase chain reaction.
References
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'874', 'DOI': '10.1177/00220345900690030901', 'article-title': 'In vitro virucidal effectiveness of a 0.12%-chlorhexidine gluconate ' 'mouthrinse.', 'volume': '69', 'author': 'Bernstein', 'year': '1990', 'journal-title': 'J Dent Res'}, { 'key': 'R12-20230928', 'doi-asserted-by': 'crossref', 'first-page': '610', 'DOI': '10.1034/j.1600-051x.2001.028007610.x', 'article-title': 'In vitro effect of oral antiseptics on human immunodeficiency virus-1 ' 'and herpes simplex virus type 1.', 'volume': '28', 'author': 'Baqui', 'year': '2001', 'journal-title': 'J Clin Periodontol'}, { 'key': 'R13-20230928', 'doi-asserted-by': 'crossref', 'first-page': '39', 'DOI': '10.1016/j.jdsr.2021.03.001', 'article-title': 'Can povidone iodine gargle/mouthrinse inactivate SARS-CoV-2 and ' 'decrease the risk of nosocomial and community transmission during the ' 'COVID-19 pandemic? An evidence-based update.', 'volume': '57', 'author': 'Chopra', 'year': '2021', 'journal-title': 'Jpn Dent Sci Rev'}, { 'key': 'R14-20230928', 'doi-asserted-by': 'crossref', 'first-page': 'e07346', 'DOI': '10.1016/j.heliyon.2021.e07346', 'article-title': 'Salivary SARS-CoV-2 load reduction with mouthwash use: a randomized ' 'pilot clinical trial.', 'volume': '7', 'author': 'Eduardo', 'year': '2021', 'journal-title': 'Heliyon'}, { 'key': 'R15-20230928', 'doi-asserted-by': 'crossref', 'first-page': '1289', 'DOI': '10.1093/infdis/jiaa471', 'article-title': 'Virucidal efficacy of different oral rinses against severe acute ' 'respiratory syndrome coronavirus 2.', 'volume': '222', 'author': 'Meister', 'year': '2020', 'journal-title': 'J Infect Dis'}, { 'key': 'R16-20230928', 'doi-asserted-by': 'crossref', 'first-page': '305', 'DOI': '10.1007/s15010-020-01563-9', 'article-title': 'Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: ' 'randomized control trial in Singapore.', 'volume': '49', 'author': 'Seneviratne', 'year': '2021', 'journal-title': 'Infection'}, { 'key': 'R17-20230928', 'doi-asserted-by': 'crossref', 'first-page': 'zqaa002', 'DOI': '10.1093/function/zqaa002', 'article-title': 'Potential role of oral rinses targeting the viral lipid envelope in ' 'SARS-CoV-2 infection.', 'volume': '1', 'author': 'O’Donnell', 'year': '2020', 'journal-title': 'Function (Oxf)'}, { 'key': 'R18-20230928', 'doi-asserted-by': 'crossref', 'first-page': '83', 'DOI': '10.1111/idh.12078', 'article-title': 'The effect of chlorhexidine dentifrice or gel versus chlorhexidine ' 'mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a ' 'systematic review.', 'volume': '13', 'author': 'Supranoto', 'year': '2015', 'journal-title': 'Int J Dent Hyg'}, { 'key': 'R19-20230928', 'doi-asserted-by': 'crossref', 'first-page': '581', 'DOI': '10.1007/s40121-019-00260-x', 'article-title': 'Infectious disease management and control with povidone iodine.', 'volume': '8', 'author': 'Eggers', 'year': '2019', 'journal-title': 'Infect Dis Ther'}, { 'key': 'R20-20230928', 'doi-asserted-by': 'crossref', 'first-page': '529', 'DOI': '10.1111/jopr.13209', 'article-title': 'Rapid in-vitro inactivation of severe acute respiratory syndrome ' 'coronavirus 2 (SARS-CoV-2) using povidone-iodine oral antiseptic rinse.', 'volume': '29', 'author': 'Bidra', 'year': '2020', 'journal-title': 'J Prosthodont'}, { 'key': 'R21-20230928', 'doi-asserted-by': 'crossref', 'first-page': '656', 'DOI': '10.1038/s41415-020-1589-4', 'article-title': 'Povidone iodine.', 'volume': '228', 'author': 'Challacombe', 'year': '2020', 'journal-title': 'Br Dent J'}, { 'key': 'R22-20230928', 'doi-asserted-by': 'crossref', 'first-page': '16', 'DOI': '10.1002/JPER.18-0183', 'article-title': 'Association between time since quitting smoking and periodontitis in ' 'former smokers in the National Health and Nutrition Examination Surveys ' '(NHANES) 2009 to 2012.', 'volume': '90', 'author': 'ALHarthi', 'year': '2012', 'journal-title': 'J Periodontol'}, { 'key': 'R23-20230928', 'first-page': '9188', 'article-title': 'A contemporary look at COVID-19 medications: available and potentially ' 'effective drugs.', 'volume': '24', 'author': 'Alshaeri', 'year': '2020', 'journal-title': 'Eur Rev Med Pharmacol Sci'}, { 'key': 'R24-20230928', 'doi-asserted-by': 'crossref', 'first-page': '101584', 'DOI': '10.1016/j.jebdp.2021.101584', 'article-title': 'In vivo evaluation of the virucidal efficacy of chlorhexidine and ' 'povidone-iodine mouthwashes against salivary SARS-CoV-2. A ' 'randomized-controlled clinical trial.', 'volume': '21', 'author': 'Elzein', 'year': '2021', 'journal-title': 'J Evid Based Dent Pract'}, { 'key': 'R25-20230928', 'doi-asserted-by': 'crossref', 'first-page': '260', 'DOI': '10.1186/s12903-019-0955-6', 'article-title': 'Annual alveolar bone loss in older adults taking oral bisphosphonate: a ' 'retrospective cohort study.', 'volume': '19', 'author': 'Helmi', 'year': '2019', 'journal-title': 'BMC Oral Health'}, { 'key': 'R26-20230928', 'doi-asserted-by': 'crossref', 'first-page': '28', 'DOI': '10.1186/s12903-020-1015-y', 'article-title': 'Annual alveolar bone loss in subjects with cardiovascular disease ' 'adjusting for associated systemic diseases and risk factors: a ' 'retrospective study.', 'volume': '20', 'author': 'Helmi', 'year': '2020', 'journal-title': 'BMC Oral Health'}, { 'key': 'R27-20230928', 'doi-asserted-by': 'crossref', 'first-page': '254', 'DOI': '10.1186/s12903-019-0925-z', 'article-title': 'Prevalence of periodontitis and alveolar bone loss in a patient ' 'population at Harvard School of Dental Medicine.', 'volume': '19', 'author': 'Helmi', 'year': '2019', 'journal-title': 'BMC Oral Health'}, { 'key': 'R28-20230928', 'doi-asserted-by': 'crossref', 'first-page': '27', 'DOI': '10.21815/JDE.019.162', 'article-title': 'Dental students’ knowledge and attitudes about electronic cigarettes: a ' 'cross-sectional study at one Saudi University.', 'volume': '84', 'author': 'Natto', 'year': '2020', 'journal-title': 'J Dent Educ'}, { 'key': 'R29-20230928', 'doi-asserted-by': 'crossref', 'DOI': '10.1111/omi.12362', 'article-title': 'Can periodontal pockets and caries lesions act as reservoirs for ' 'Coronavirus?', 'author': 'Natto', 'year': '2022', 'journal-title': 'Mol Oral Microbiol'}, { 'key': 'R30-20230928', 'doi-asserted-by': 'crossref', 'first-page': '9547', 'DOI': '10.2147/IJGM.S331611', 'article-title': 'Characteristics of oral manifestations in symptomatic non-hospitalized ' 'COVID-19 patients: a cross-sectional study on a sample of the Saudi ' 'Population.', 'volume': '14', 'author': 'Natto', 'year': '2021', 'journal-title': 'Int J Gen Med'}, { 'key': 'R31-20230928', 'doi-asserted-by': 'crossref', 'first-page': '406', 'DOI': '10.4103/njcp.njcp_259_20', 'article-title': 'Are saudi healthcare students aware of COVID-19, and do they behave ' 'safely during viral outbreaks?', 'volume': '24', 'author': 'Natto', 'year': '2021', 'journal-title': 'Niger J Clin Pract'}, { 'key': 'R32-20230928', 'doi-asserted-by': 'crossref', 'first-page': '315', 'DOI': '10.2147/RMHP.S278394', 'article-title': 'Characteristics of first cases of coronavirus disease 2019 and the ' 'effort to prevent the early spread of COVID-19 in Saudi Arabia.', 'volume': '14', 'author': 'Natto', 'year': '2021', 'journal-title': 'Risk Manag Healthc Policy'}, { 'key': 'R33-20230928', 'doi-asserted-by': 'crossref', 'first-page': '2951', 'DOI': '10.2147/JMDH.S330567', 'article-title': 'Infection control practices at the dental clinics in Jeddah, Saudi ' 'Arabia.', 'volume': '14', 'author': 'Natto', 'year': '2021', 'journal-title': 'J Multidiscip Healthc'}, { 'key': 'R34-20230928', 'doi-asserted-by': 'crossref', 'first-page': '649', 'DOI': '10.1111/jcpe.12722', 'article-title': 'Efficacy of collagen matrix seal and collagen sponge on ridge ' 'preservation in combination with bone allograft: a randomized ' 'controlled clinical trial.', 'volume': '44', 'author': 'Natto', 'year': '2017', 'journal-title': 'J Clin Periodontol'}], 'container-title': 'Medicine', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://journals.lww.com/10.1097/MD.0000000000028925', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 9, 28]], 'date-time': '2023-09-28T03:29:29Z', 'timestamp': 1695871769000}, 'score': 1, 'resource': {'primary': {'URL': 'https://journals.lww.com/10.1097/MD.0000000000028925'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 7, 29]]}, 'references-count': 33, 'journal-issue': {'issue': '30', 'published-online': {'date-parts': [[2022]]}}, 'URL': 'http://dx.doi.org/10.1097/MD.0000000000028925', 'relation': {}, 'ISSN': ['1536-5964'], 'subject': ['General Medicine'], 'published': {'date-parts': [[2022, 7, 29]]}}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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