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Efficacy of different mouthwashes against COVID-19: A systematic review and network meta-analysis

Sbricoli et al., Japanese Dental Science Review, doi:10.1016/j.jdsr.2023.09.003, PROSPERO CRD42022318922
Oct 2023  
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Systematic review and network meta-analysis evaluating the effectiveness of antiseptic mouthwashes in reducing SARS-CoV-2 viral load in saliva based on data from 14 randomized clinical trials and 21 in vitro studies. The study found that the most commonly tested mouthwash was chlorhexidine, either alone or in combination with other active ingredients, followed by povidone-iodine, hydrogen peroxide, and cetylpyridinium chloride. The descriptive analysis indicated that mouthwashes are effective in reducing salivary viral load, both in clinical settings and in vitro. The network meta-analysis showed a high degree of heterogeneity. Chlorhexidine 0.20% demonstrated a significant increase in cycle threshold (Ct) in saliva five minutes after rinsing compared to a non-active control, while improvements for other mouthwashes were not statistically significant. Authors note that while data suggests the antiviral efficacy of commonly used mouthwashes, large, well-balanced trials are necessary to establish the best rinsing protocols​​.
2 meta analyses show significant improvements with povidone-iodine for viral load Hasan, Idrees and viral clearance Hasan.
Currently there are 20 povidone-iodine for COVID-19 studies, showing 72% lower mortality [8‑92%], 76% lower hospitalization [-14‑95%], and 45% fewer cases [20‑62%].
This study includes povidone-iodine, cetylpyridinium chloride, chlorhexidine, and hydrogen peroxide.
Sbricoli et al., 11 Oct 2023, peer-reviewed, 6 authors, trial PROSPERO CRD42022318922.
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Efficacy of different mouthwashes against COVID-19: A systematic review and network meta-analysis
Luca Sbricoli, Lucia Schiavon, Giulia Brunello, Paola Brun, Kathrin Becker, Stefano Sivolella
Japanese Dental Science Review, doi:10.1016/j.jdsr.2023.09.003
To evaluate the effectiveness of antiseptic mouthwashes in reducing SARS-CoV-2 load clinically and in vitro. A systematic electronic search (MEDLINE/Scopus/Cochrane) was conducted to identify prospective clinical and in vitro studies published between 2019 included and 16 June 2023 assessing the effectiveness of mouthwashes in reducing SARS-CoV-2 load in saliva or surrogates. Data were summarized in tables and a network meta-analysis was performed for clinical trials. Thirty-five studies (14 RCTs, 21 in vitro) fulfilled the inclusion criteria. The risk of bias was judged to be high for 2 clinical and 7 in vitro studies. The most commonly test product was chlorhexidine alone or in combination with other active ingredients, followed by povidone-iodine, hydrogen peroxide and cetylpyridinium chloride. Overall, the descriptive analysis revealed the effectiveness of the mouthwashes in decreasing the salivary viral load both clinically and in vitro. Network meta-analysis demonstrated a high degree of heterogeneity. Among these studies, only chlorhexidine 0.20% was associated to a significant Ct increase in the saliva 5 min after rinsing compared to non-active control (p = 0.027). Data from clinical and in vitro studies suggested the antiviral efficacy of commonly used mouthwashes. Large well-balanced trials are needed to identify the best rinsing protocols.
Conflict of Interest The authors declare no conflict of interest.
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