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Effect of oral antiseptics in reducing SARS-CoV-2 infectivity: evidence from a randomized double-blind clinical trial

Sánchez Barrueco et al., Emerging Microbes & Infections, doi:10.1080/22221751.2022.2098059, NCT04707742
Jul 2022  
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0 0.5 1 1.5 2+ Viral load, 60 min 75% no CI Improvement Relative Risk Viral load, 30min -55% no CI Hydrogen Peroxide  Sánchez Barrueco et al.  LATE TREATMENT  DB RCT Favors hydrogen peroxide Favors control
19th treatment shown to reduce risk in May 2021
*, now known with p = 0.029 from 7 studies.
Lower risk for viral clearance.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments.
RCT hospitalized patients testing viral load shortly after a single mouthwash with PVP-I, hydrogen peroxide, cetylpyridinium chloride, chlorhexidine, and water. For PVP-I, there were only 5 patients with viable virus at baseline. Cross-treatment comparisons are limited due to the very small sample sizes and large difference between baseline viral loads (the baseline viral culture non-log copies/mL was ~10,000 times higher in the water group vs. PVP-I).
The trial registration shows that 160 patients were recruited, with 62 patients added in an October 6, 2021 change, however the paper presents results for only 75 patients.
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.
Study covers hydrogen peroxide and povidone-iodine.
risk of viral load, 75.2% lower, RR 0.25, treatment 5, control 5, relative viral culture non-log median copies/mL, 60 minutes vs. baseline.
risk of viral load, 54.7% higher, RR 1.55, treatment 5, control 5, relative viral culture non-log median copies/mL, 30 minutes vs. baseline.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sánchez Barrueco et al., 27 Jul 2022, Double Blind Randomized Controlled Trial, placebo-controlled, Spain, peer-reviewed, mean age 55.0, 17 authors, study period 15 June, 2020 - 30 September, 2021, trial NCT04707742 (history). Contact:
This PaperHydrogen Per..All
Effect of oral antiseptics in reducing SARS-CoV-2 infectivity: evidence from a randomized double-blind clinical trial
Álvaro Sánchez Barrueco, María Victoria Mateos-Moreno, Yolanda Martínez-Beneyto, Elisa García-Vázquez, Alfonso Campos González, Javier Zapardiel Ferrero, Abel Bogoya Castaño, Ignacio Alcalá Rueda, José Miguel Villacampa Aubá, Carlos Cenjor Español, Laura Moreno-Parrado, Verónica Ausina-Márquez, Sandra García-Esteban, Alejandro Artacho, F Xavier López-Labrador, Alex Mira, María D Ferrer
Emerging Microbes & Infections, doi:10.1080/22221751.2022.2098059
Background: In vitro studies have shown that several oral antiseptics have virucidal activity against SARS-CoV-2. Thus, mouthwashes have been proposed as an easy to implement strategy to reduce viral transmission. However, there are no data measuring SARS-CoV-2 viability after mouthwashes in vivo. Methods: In this randomized double-blind, fiveparallel-group, placebo-controlled clinical trial, SARS-CoV-2 salivary viral load (by quantitative PCR) and its infectious capacity (incubating saliva in cell cultures) have been evaluated before and after four different antiseptic mouthwashes and placebo in 54 COVID-19 patients. Results: Contrary to in vitro evidence, salivary viral load was not affected by any of the four tested mouthwashes. Viral culture indicated that cetylpyridinium chloride (CPC) significantly reduced viral infectivity, but only at 1-hour post-mouthwash. Conclusion: These results indicate that some of the mouthwashes currently used to reduce viral infectivity are not efficient in vivo and, furthermore, that this effect is not immediate, generating a false sense of security.
Disclosure statement No potential conflict of interest was reported by the author(s). Author contributions
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Late treatment
is less effective
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