In Vivo Efficacy of Povidone-iodine Mouth Gargles in Reducing Salivary Viral Load in COVID-19 Patients: A Systematic Review
Sudhakar et al.
, In Vivo Efficacy of Povidone-iodine Mouth Gargles in Reducing Salivary Viral Load in COVID-19 Patients: A..
, World Journal of Dentistry, doi:10.5005/jp-journals-10015-1868 (meta analysis)
Systematic review of the use of povidone-iodine gargles for COVID-19, concluding that PVP-I effectively reduces SARS-CoV-2 viral load.
Currently there are 20 povidone-iodine studies
and meta analysis shows:
Sudhakar et al., 24 Nov 2021, peer-reviewed, 5 authors.
Abstract: REVIEW ARTICLE
In Vivo Efficacy of Povidone-iodine Mouth Gargles in
Reducing Salivary Viral Load in COVID-19 Patients:
A Systematic Review
TS Vinodhini Sudhakar1, Sudhakar Venkatachalapathy2, Balaguhan Balasubramanian3, Kirthika Natarajan4,
Mathan M Aiyathurai5
A b s t r ac t
Aim and objective: Based on the published research, this article aims to systematically review the in vivo effectiveness of povidone-iodine
(PVP-I) mouth gargles in reducing salivary viral load in COVID-19 patients.
Materials and methods: The inhibitory potential of different variables such as PVP-I, chlorhexidine gluconate (CHX), cetylpyridinium chloride
(CPC), saline, and hydrogen peroxide (H2O2) were tested against SARS-CoV-2 in recent clinical trials. In this systematic review, appropriate
randomized controlled trials (RCTs) for the evidence-based question: “what is the efficacy of PVP-I mouth gargle in reducing salivary viral load
in COVID-19 patients?” were searched in Medline/PubMed, Scopus, Science Direct, Embase, Google Scholar, and the Cochrane Library database
from January 15, 2020, to June 15, 2021, based on defined inclusion and exclusion criteria. From the selected articles, their references and
reviews relevant to our topic were also looked for any missed studies.
Results: After a pertinent search for appropriate studies, five in vivo RCTs were selected and others were excluded. All the trials used reverse
transcription-polymerase chain reaction (RT-PCR) for mRNA detection and quantitation. Povidone-iodine mouth gargle (0.5–1%) used by COVID19 patients 4th hourly effectively reduced salivary SARS-CoV-2 viral load, thereby reducing the carriage of infectious virion in adults. Statistically
significant increase in Ct values, post 5, 15, and 45 minutes, 3 and 6 hours post-rinsing demonstrated the strong antiviral effect of PVP-I.
Conclusion: In this COVID-19 pandemic, based on the published evidence of a few in vivo RCTs, it can be concluded that 0.5 to 1% PVP-I mouth
gargle has the potency to effectively reduce the salivary SARS-CoV-2 viral load. To reinforce the use of PVP-I mouth gargles against SARS-CoV-2,
this systematic review emphasizes the necessity for future research that is highly focused, robust, and has consistent techniques and a large
Clinical significance: Research on the efficacy of PVP-I mouth gargle should be framed to focus on the most effective minimal concentration,
exposure time, and volume of mouth gargle as well as the SARS-CoV-2 strain. The effect of PVP-I mouth gargles on viral infectivity and their
cytotoxic effect on epithelial cells were not distinguished in the studies reviewed. Hence, viral cell culture technique should be employed to
establish the potential virucidal activity of PVP-I against SARS-CoV-2. Host immunity against SARS-CoV-2 should also be considered in assessing
the effectiveness of mouth gargles.
Keywords: COVID-19, Mouth Gargle, Povidone-iodine, SARS-CoV-2, Treatment.
World Journal of Dentistry (2021): 10.5005/jp-journals-10015-1868
I n t r o d u c t i o n
COVID-19 disease caused by SARS-CoV-2 is creating severe
community and nosocomial outbreaks globally. The highly
contagious nature and easy transmissibility of this Virion have
made COVID-19 pandemic, alarmingly increasing the number of
infections and death every day. The 2019 novel corona virus (SARSCoV-2) is phylogenetically related to Bat SARS-like coronaviruses
and belongs to the Betacoronavirus genus lineage B.1,2 However,
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, 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
provide treatment protocols.