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0 0.5 1 1.5 2+ Recovery -27% Improvement Relative Risk Recovery (b) -50% Viral clearance 0% Zarabanda et al. Povidone-Iodine for COVID-19 RCT LATE Is late treatment with povidone-iodine beneficial for COVID-19? RCT 24 patients in the USA Trial compares with saline spray, results vs. placebo may differ Trial underpowered to detect differences Zarabanda et al., Laryngoscope, doi:10.1002/lary.29935 Favors povidone-iodine Favors saline spray
The Effect of Povidone-Iodine Nasal Spray on COVID-19 Nasopharyngeal Viral Load in Patients: A Randomized Control Trial
Zarabanda et al., Laryngoscope, doi:10.1002/lary.29935
Zarabanda et al., The Effect of Povidone-Iodine Nasal Spray on COVID-19 Nasopharyngeal Viral Load in Patients: A Randomized.., Laryngoscope, doi:10.1002/lary.29935
Nov 2021   Source   PDF  
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Very late treatment (7 days from onset) RCT comparing 11 & 13 PVP-I (0.5% and 2%), and 11 saline spray patients in the USA, showing no significant differences. There was no control group (saline is likely not a placebo, showing efficacy in other trials). There are large unadjusted differences between groups, e.g. 7.1 days from onset for PVP-I versus 4.8 for saline. Baseline Ct was higher for PVP-I, providing less room for improvement. Authors note that they cannot determine if earlier use is more beneficial.
risk of no recovery, 26.9% higher, RR 1.27, p = 1.00, treatment 3 of 13 (23.1%), control 2 of 11 (18.2%), 2%.
risk of no recovery, 50.0% higher, RR 1.50, p = 1.00, treatment 3 of 11 (27.3%), control 2 of 11 (18.2%), 0.5%.
risk of no viral clearance, no change, RR 1.00, p = 1.00, treatment 2 of 7 (28.6%), control 2 of 7 (28.6%), day 5, minus strand PCR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zarabanda et al., 1 Nov 2021, Randomized Controlled Trial, USA, peer-reviewed, 13 authors, average treatment delay 7.0 days, this trial compares with another treatment - results may be better when compared to placebo.
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This PaperPovidone-Iod..All
The Effect of Povidone‐Iodine Nasal Spray on Nasopharyngeal SARS‐CoV‐2 Viral Load: A Randomized Control Trial
MD David Zarabanda, MD Neelaysh Vukkadala, MD Katie M Phillips, Z Jason Qian, Kenji O Mfuh, Matthew J Hatter, MD Ivan T Lee, MD Vidya K Rao, MD Peter H Hwang, MD George Domb, Orcid ID Zara M Patel, MD PhD Benjamin A Pinsky, MD PhD Jayakar V Nayak
The Laryngoscope, doi:10.1002/lary.29935
Objectives To determine the effect of povidone-iodine (PVP-I) nasal sprays on nasopharyngeal (NP) viral load as assessed by cycle threshold on quantitative polymerase chain reaction (qPCR) of SARS-CoV-2 in outpatients. Study Design Three arm, triple blinded, randomized, placebo-controlled clinical trial. Methods Participants were randomized within 5 days of testing positive for COVID-19 to receive nasal sprays containing either placebo (0.9% saline), 0.5% PVP-I, or 2.0% PVP-I. NP swabs for qPCR analysis were taken at baseline, 1-hour post-PVP-I spray (2 sprays/nostril),
Anderson, David, Scholz, Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares, Antimicrob Agents Chemother, doi:10.1128/AAC.04624-14
Anderson, Sivalingam, Kang, Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease, Infect Dis Ther, doi:10.1007/s40121-020-00316-3
Baden, Sahly, Essink, Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine, N Engl J Med, doi:10.1056/NEJMoa2035389
Cevik, Tate, Lloyd, Maraolo, Schafers et al., SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis, The Lancet Microbe, doi:10.1016/S2666-5247(20)30172-5
Corman, Landt, Kaiser, Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR, Eurosurveillance, doi:10.2807/1560-7917.ES.2020.25.3.2000045
Doty, Shaman, Dann, Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function, Physiol Behav, doi:10.1016/0031-9384(84)90269-5
Fajnzylber, Regan, Coxen, SARS-CoV-2 viral load is associated with increased disease severity and mortality, Nat Commun, doi:10.1038/s41467-020-19057-5
Forum, More on Betadine from JAMA
Frank, Brown, Capriotti, Westover, Pelletier et al., In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2, JAMA Otolaryngol -Head Neck Surg, doi:10.1001/jamaoto.2020.3053
Gluck, Martin, Bosse, Reimer, Mueller, A clinical study on the tolerability of a liposomal povidone-iodine nasal spray: Implications for further development, ORL, doi:10.1159/000097758
Guenezan, Garcia, Strasters, Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19, JAMA Otolaryngol Neck Surg, doi:10.1001/jamaoto.2020.5490
Hogan, Huang, Sahoo, Strand-Specific Reverse Transcription PCR for Detection of Replicating SARS-CoV-2, Emerg Infect Dis, doi:10.3201/eid2702.204168
Hogan, Sahoo, Huang, Comparison of Panther Fusion and a laboratory-developed test targeting the envelope gene for detection of SARS-CoV-2, J Clin Virol, doi:10.1016/j.jcv.2020.104383
Kirk-Bayley, Challacombe, Sunkaraneni, Combes, The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Protect Healthcare Workers and Reduce Cross Infection, SSRN Electron J, doi:10.2139/ssrn.3563092
Lee, Nakayama, Wu, ACE2 localizes to the respiratory cilia and is not increased by ACE inhibitors or ARBs, Nat Commun, doi:10.1038/s41467-020-19145-6
Mangram, Horan, Pearson, Silver, Jarvis, Guideline for Prevention of Surgical Site Infection, 1999, Infect Control Hosp Epidemiol, doi:10.1086/501620
Polack, Thomas, Kitchin, Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine, N Engl J Med, doi:10.1056/NEJMoa2034577
Sungnak, Huang, Bécavin, SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes, Nat Med, doi:10.1038/s41591-020-0868-6
Urbaniak, Plous, Research Randomizer
Yan, Faraji, Prajapati, Boone, Deconde, Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms, Int Forum Allergy Rhinol, doi:10.1002/alr.22579
Zacharioudakis, Prasad, Zervou, Association of SARS-CoV-2 Genomic Load with COVID-19 Patient Outcomes, Ann Am Thorac Soc, doi:10.1513/AnnalsATS.202008-931RL
Late treatment
is less effective
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