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.
Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture.
Porter show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.
Targeted administration to the respiratory tract provides treatment directly
to the typical source of initial SARS-CoV-2 infection and replication, and
allows for rapid onset of action, higher local drug concentration, and reduced systemic side effects (early treatment may be 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.
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),
References
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
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
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
Mangram, Horan, Pearson, Silver, Jarvis, Guideline for Prevention of Surgical Site Infection, 1999, Infect Control Hosp Epidemiol,
doi:10.1086/501620
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