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),
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doi:10.1002/alr.22579{ 'indexed': {'date-parts': [[2024, 3, 30]], 'date-time': '2024-03-30T12:27:53Z', 'timestamp': 1711801673607},
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'abstract': '<jats:sec><jats:title>Objectives/Hypothesis</jats:title><jats:p>To determine the effect of '
'povidone‐iodine (PVP‐I) nasal sprays on nasopharyngeal (NP) viral load as assessed by cycle '
'threshold (Ct) on quantitative polymerase chain reaction (qPCR) of SARS‐CoV‐2 in '
'outpatients.</jats:p></jats:sec><jats:sec><jats:title>Study Design</jats:title><jats:p>Three '
'arm, triple blinded, randomized, placebo‐controlled clinical '
'trial.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Participants were '
'randomized within 5\u2009days of testing positive for COVID‐19 to receive nasal sprays '
'containing 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 (two sprays/nostril), and 3\u2009days post‐PVP‐I '
'spray (20 sprays/nostril). Symptom and adverse event questionnaires were completed at '
'baseline, day 3, and day 5. University of Pennsylvania Smell Identification Tests (UPSIT) '
'were completed at baseline and day '
'30.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean Ct values '
'increased over time in all groups, indicating declining viral loads, with no statistically '
'significant difference noted in the rate of change between placebo and PVP‐I groups. The 2.0% '
'PVP‐I group showed statistically significant improvement in all symptom categories; however, '
'it also reported a high rate of nasal burning. Olfaction via UPSIT showed improvement by at '
'least one category in all groups. There were no hospitalizations or mortalities within '
'30\u2009days of study '
'enrollment.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Saline '
'and low concentration PVP‐I nasal sprays are well tolerated. Similar reductions in SARS‐CoV‐2 '
'NP viral load were seen over time in all groups. All treatment groups showed improvement in '
'olfaction over 30\u2009days. These data suggest that dilute versions of PVP‐I nasal spray are '
'safe for topical use in the nasal cavity, but that PVP‐I does not demonstrate virucidal '
'activity in COVID‐19 positive outpatients.</jats:p></jats:sec><jats:sec><jats:title>Level of '
'Evidence</jats:title><jats:p>2 <jats:italic>Laryngoscope</jats:italic>, 132:2089–2095, '
'2022</jats:p></jats:sec>',
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