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0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Mohamed (RCT) 86% 0.14 [0.01-2.21] viral+ 0/5 3/5 Improvement, RR [CI] Treatment Control Choudhury (RCT) 88% 0.12 [0.03-0.50] death 2/303 17/303 Guenezan (RCT) 63% 0.37 [0.06-1.63] viral load 12 (n) 12 (n) Elzein (DB RCT) 89% 0.11 [0.01-1.00] viral load 25 (n) 9 (n) Arefin (RCT) 79% 0.21 [0.08-0.54] viral+ 4/27 19/27 Baxter (RCT) 65% 0.35 [0.01-8.27] hosp. 0/37 1/42 OT​1 Pablo-Marcos 29% 0.71 [0.32-1.56] viral load 31 (n) 40 (n) Tau​2 = 0.15; I​2 = 22.0% Early treatment 71% 0.29 [0.16-0.54] 6/440 40/438 71% improvement Zarabanda (RCT) -27% 1.27 [0.26-6.28] no recov. 3/13 2/11 OT​1 Improvement, RR [CI] Treatment Control Tau​2 = 0.00; I​2 = 0.0% Late treatment -27% 1.27 [0.26-6.28] 3/13 2/11 -27% improvement Seet (CLUS. RCT) 45% 0.55 [0.38-0.80] severe case 42/735 64/619 OT​1 Improvement, RR [CI] Treatment Control Tau​2 = 0.00; I​2 = 0.0% Prophylaxis 45% 0.55 [0.38-0.80] 42/735 64/619 45% improvement All studies 60% 0.40 [0.25-0.65] 51/1,188 106/1,068 60% improvement 9 povidone-iodine COVID-19 studies Dec 5, 2021 1 OT: comparison with other treatmentTau​2 = 0.16; I​2 = 33.4%; Z = 3.71 Effect extraction pre-specified, see appendix Favors povidone-iodine Favors control
Database of all povidone-iodine COVID-19 studies. Submit updates/corrections.
Restrict:    All    Early    Late    Prophylaxis
Dec 5
Early, Late, PrEP, PEP Covid Analysis (Preprint) (meta analysis)
Povidone-Iodine for COVID-19: real-time meta analysis of 9 studies
Details   • Meta analysis using the most serious outcome reported shows 60% [35‑75%] improvement. Results are similar for Randomized Controlled Trials, similar after exclusions, and similar for peer-reviewed studies. Early treatment show..
Nov 1
Late Zarabanda et al., Laryngoscope, doi:10.1002/lary.29935 (Peer Reviewed)
no recov., ↑26.9%, p=1.00
The Effect of Povidone-Iodine Nasal Spray on COVID-19 Nasopharyngeal Viral Load in Patients: A Randomized Control Trial
Details   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 i..
Oct 25
Early Pablo-Marcos et al., Enfermedades Infecciosas y Microbiología Clínica, doi:10.1016/j.eimc.2021.10.005 (Peer Reviewed)
viral load, ↓29.2%, p=0.40
Utilidad de los enjuagues con povidona yodada y peroxido de hidrogeno en pacientes con COVID-19
Details   Small prospective study with 31 patients gargling povidone-iodine, 17 hydrogen peroxide, and 40 control patients, showing lower viral load mid-recovery with povidone-iodine, without reaching statistical significance. Oropharyngeal only, a..
Oct 3
Safety Frank et al., Otolaryngology - Head and Neck Surgery, 165:89 (Preprint) Tolerance of nasal and oral povidone-iodine antisepsis amid COVID-19 pandemic
Details   Prospective study of 42 otolaryngology and dental patients, showing low-dose nasal and oral PVP-I solutions to be well-tolerated.
Aug 17
Early Baxter et al., medRxiv, doi:10.1101/2021.08.16.21262044 (Preprint)
hosp., ↓65.3%, p=1.00
Rapid initiation of nasal saline irrigation: hospitalizations in COVID-19 patients randomized to alkalinization or povidone-iodine compared to a national dataset
Details   Small RCT 79 PCR+ patients 55+ comparing pressure-based nasal irrigation with povidone-iodine and sodium bicarbonate, showing improved recovery with povidone-iodine, and 0/37 COVID-19 related hospitalizations for povidone-iodine compared ..
May 18
Early Arefin et al., Indian Journal of Otolaryngology and Head & Neck Surgery, doi:10.1007/s12070-021-02616-7 (Peer Reviewed)
viral+, ↓78.9%, p=0.02
Virucidal effect of povidone iodine on COVID-19 in the nasopharynx: an open-label randomized clinical trial
Details   RCT with 189 patients showing significantly greater viral clearance with a single application of PVP-I. Authors recommend using PVP-I prophylactically in the nasopharynx and oropharynx. NCT04549376 [1].
Apr 14
PrEPPEP Seet et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2021.04.035 (Peer Reviewed)
severe case, ↓44.7%, p=0.05
Positive impact of oral hydroxychloroquine and povidone-iodine throat spray for COVID-19 prophylaxis: an open-label randomized trial
Details   Prophylaxis RCT in Singapore with 3,037 low risk patients, showing lower serious cases, lower symptomatic cases, and lower confirmed cases of COVID-19 with all treatments (ivermectin, HCQ, PVP-I, and Zinc + vitamin C) compared to vitamin ..
Apr 8
PrEPPEP Arefin, M., Indian Journal of Otolaryngology and Head & Neck Surgery, doi:10.1007/s12070-021-02525-9 (Peer Reviewed) Povidone Iodine (PVP-I) Oro-Nasal Spray: An Effective Shield for COVID-19 Protection for Health Care Worker (HCW), for all
Details   Report on clinical experience with prophylactic use of PVP-I for COVID-19 in a very high risk environment with no infections, review of the use of PVP-I for the prevention of respiratory infections, and recommendations for use with COVID-..
Mar 17
Early Elzein et al., Journal of Evidence Based Dental Practice, doi:10.1016/j.jebdp.2021.101584 (preprint 3/17) (Peer Reviewed)
viral load, ↓88.8%, p<0.05
In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial
Details   Small RCT comparing mouthwashing with PVP-I, Chlorhexidine, and water, showing significant efficacy for both PVP-I and Chlorhexidine, with PVP-I increasing Ct by a mean of 4.45 (p < 0.0001) and Chlorhexidine by a mean of 5.69 (p < 0.0001)..
Mar 15
Review Chopra et al., Japanese Dental Science Review, doi:10.1016/j.jdsr.2021.03.001 (Review) (Peer Reviewed)
Can povidone Iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence-based update
Details   Review discussing the rationale, safety, recommendations, and dosage of PVP-I gargle/mouthwash as an effective method to decrease the viral load of SARS-CoV-2.
Mar 1
In Vitro Xu et al., Pathogens, doi:10.3390/pathogens10030272 (Peer Reviewed) (In Vitro)
in vitro
Differential Effects of Antiseptic Mouth Rinses on SARS-CoV-2 Infectivity In Vitro
Details   In Vitro study showing that PVP-I and other mouthwashes inactivated replication-competent SARS-CoV-2.
Mar 1
Early Jayaraman et al., medRxiv, doi:10.1101/2021.02.25.21252488 (Preprint) Povidone iodine, hydrogen peroxide and chlorhexidine mouthwashes reduce SARS-CoV2 burden in whole mouth fluid and respiratory droplets
Details   Study of SARS-CoV2 burden in whole mouth fluid and respiratory droplets with povidone iodine, hydrogen peroxide, and chlorhexidine mouthwashes in 36 hospitalized COVID-19 patients using PCR and rapid antigen testing. There were significan..
Feb 4
Early Guenezan et al., JAMA Otolaryngol Head Neck Surg., doi:10.1001/jamaoto.2020.5490 (Peer Reviewed)
viral load, ↓63.2%, p=0.25
Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19: A Randomized Clinical Trial
Details   RCT of PCR+ patients with Ct<=20 with 12 treatment and 12 control patients, concluding that nasopharyngeal decolonization may reduce the carriage of infectious SARS-CoV-2 in adults with mild to moderate COVID-19. All patients but 1 had ne..
Feb 1
In Vitro Tucker et al., bioRxiv, doi:10.1101/2021.01.31.426979 (Preprint) (In Vitro)
in vitro
In vitro inactivation of SARS-CoV-2 with 0.5% povidone iodine nasal spray (Nasodine) at clinically relevant concentrations and timeframes using tissue culture and PCR based assays
Details   In Vitro study showing that PVP-I eliminated the viability of SARS-CoV-2 with short exposure times. Authors find that PCR alone may not be adequate for viral quantification and recommend incorporating cell culture to assess viral viability.
Jan 3
Early Khan et al., American Journal of Otolaryngology, doi:10.1016/j.amjoto.2020.102880 (Peer Reviewed) Tolerability and usability of 0.5% PVP-I gargles and nasal drops in 6692 patients: Observational study
Details   Study of the use of PVP-I gargles and nasal drops before and after ENT examinations with a total of 6,692 patients, finding high usability and good tolerance for use. 21 patients (0.76%) reported an itching sensation in the nose on the f..
Dec 14
Early Seneviratne et al., Infection, doi:10.1007/s15010-020-01563-9 (Peer Reviewed) Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore
Details   Small mouthwash RCT with 4 PVP-I patients and 2 water patients concluding that PVP-I may have a sustained effect on reducing the salivary SARS-CoV-2 level in COVID-19 patients.
Dec 3
Early Choudhury et al., Bioresearch Communications, Volume 7, Issue 1, January 2021 (Peer Reviewed)
death, ↓88.2%, p=0.0006
Effect of 1% Povidone Iodine Mouthwash/Gargle, Nasal and Eye Drop in COVID-19 patient
Details   RCT 606 patients in Bangladesh for povidone iodine mouthwash/gargle, nasal drops and eye drops showing significantly lower death, hospitalization, and PCR+ at day 7.
Sep 17
In Vitro Frank et al., JAMA Otolaryngol Head Neck Surg, doi:10.1001/jamaoto.2020.3053 (Peer Reviewed) (In Vitro)
in vitro
In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2
Details   In Vitro study showing povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact. No cytotoxic effects on cells were observed after contact with each of the ..
Sep 9
Early Mohamed et al., medRxiv, doi:10.1101/2020.09.07.20180448 (Preprint)
viral+, ↓85.7%, p=0.17
Early viral clearance among COVID-19 patients when gargling with povidone-iodine and essential oils: a pilot clinical trial
Details   Tiny RCT with 5 PVP-I patients, gargling 30 seconds, 3x per day, and 5 control patients (essential oils and tap water were also tested), showing improved viral clearance with PVP-I.
Jul 8
In Vitro Anderson et al., Infectious Diseases and Therapy, doi:10.1007/s40121-020-00316-3 (Peer Reviewed) (In Vitro)
in vitro
Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease
Details   In Vitro study showing rapid and effective virucidal activity of PVP-I against SARS-CoV-2. All four products tested [antiseptic solution (PVP-I 10%), skin cleanser (PVP-I 7.5%), gargle and mouth wash (PVP-I 1%) and throat spray (PVP-I 0.4..
Jul 2
Early Martínez Lamas et al., Oral Diseases, (Peer Reviewed) Is povidone iodine mouthwash effective against SARS‐CoV‐2? First in vivo tests
Details   Small study analyzing the impact of PVP-I mouthwash on the salivary viral load of SARS‐CoV‐2 in 4 patients with COVID‐19. In 2 of the 4 patients (those with a higher initial viral load), PVP‐I resulted in a significant drop in viral load,..
Jun 26
In Vitro Hassandarvish et al., British Dental Journal volume, doi:10.1038/s41415-020-1794-1 (Peer Reviewed) (In Vitro)
in vitro
Povidone iodine gargle and mouthwash
Details   In Vitro study showing undiluted PVP-I (1% w/v) achieved >5 log10 reduction in SARS-CoV-2 virus titres at 15, 30 and 60 seconds treatment exposure under both clean and dirty conditions. In contrast, when PVP-I was tested at 1:2 dilution a..
Jun 18
Early Khan et al., Am J Otolaryngol, doi:10.1016/j.amjoto.2020.102618 (Peer Reviewed) Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic
Details   Study of the use of PVP-I gargles and nasal drops before ENT appointments finding good tolerability.
Jun 10
Safety Frank et al., Ear, Nose & Throat Journal, doi:10.1177/0145561320932318 (Peer Reviewed)
safety analysis
Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era
Details   Review of povidone-iodine finding that it can safely be used in the nose at concentrations up to 1.25% and in the mouth at concentrations up to 2.5% for up to 5 months.
Jun 8
In Vitro Bidra et al., Journal of Prosthodontics, doi:10.1111/jopr.13209 (Peer Reviewed) (In Vitro)
in vitro
Rapid In‐Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) Using Povidone‐Iodine Oral Antiseptic Rinse
Details   In Vitro study showing PVP‐I rapidly inactivated SARS‐CoV‐2. Viricidal activity was present at the lowest concentration and contact time tested (0.5% PVP‐I and 15 seconds).
May 7
PrEPPEP Mendoza et al., SSRN, doi:10.2139/ssrn.3589404 (Preprint) Prevention of COVID-19 Infection with Povidone-Iodine
Details   Review of the antiviral efficacy of PVP-I and its potential use as a prophylactic on the oropharyngeal and nasopharyngeal mucosa for COVID-19.
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