PVP-I for COVID-19: real-time analysis of all 16 studies

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3/17	Early	Elzein et al., medRxiv, doi:10.1101/2021.03.07.21252302 (Preprint)		In vivo evaluation of the virucidal efficacy of Chlorhexidine and Povidone-iodine mouthwashes against salivary SARS-CoV-2
	Small RCT comparing mouthwashing with PVP-I, Chlorhexidine, and water, showing both PVP-I and Chlorhexidine were effective, 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), compared..
3/17	Details Source PDF Early treatment study Early treatment study
	Elzein et al., medRxiv, doi:10.1101/2021.03.07.21252302 (Preprint)
	In vivo evaluation of the virucidal efficacy of Chlorhexidine and Povidone-iodine mouthwashes against salivary SARS-CoV-2
	Small RCT comparing mouthwashing with PVP-I, Chlorhexidine, and water, showing both PVP-I and Chlorhexidine were effective, 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), compared to no significant difference for water.
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3/15	Review	Chopra et al., Japanese Dental Science Review, doi:10.1016/j.jdsr.2021.03.001 (Review) (Peer Reviewed)	review	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
	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.
3/15	Details Source PDF Review 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
	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.
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3/1	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
	In Vitro study showing that PVP-I and other mouthwashes inactivated replication-competent SARS-CoV-2.
3/1	Details Source PDF In Vitro In Vitro
	Xu et al., Pathogens, doi:10.3390/pathogens10030272 (Peer Reviewed) (In Vitro)
	Differential Effects of Antiseptic Mouth Rinses on SARS-CoV-2 Infectivity In Vitro
	In Vitro study showing that PVP-I and other mouthwashes inactivated replication-competent SARS-CoV-2.
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3/1	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
	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..
3/1	Details Source PDF Early treatment study Early treatment study
	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
	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 significant reductions in SARS-CoV2 burden with all treatments in both respiratory droplets and whole mouth fluid.
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2/4	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
	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..
2/4	Details Source PDF Early treatment study Early treatment study
	Guenezan et al., JAMA Otolaryngol Head Neck Surg., doi:10.1001/jamaoto.2020.5490 (Peer Reviewed)
	Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19: A Randomized Clinical Trial
	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 negative viral titer by day 3 (group not specified). There was no significant difference in viral RNA quantification over time. The mean relative difference in viral titers between baseline and day 1 was 75% [43%-95%] in the intervention group and 32% [10%-65%] in the control group. Thyroid dysfunction occurred in 42% of treated patients, with spontaneous resolution after the end of treatment. Patients in the treatment group were younger. relative improvement in viral titer reduction between baseline and day 1, 63.2% lower, RR 0.37, p = 0.25, treatment 12, control 12.
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2/1	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
	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.
2/1	Details Source PDF In Vitro In Vitro
	Tucker et al., bioRxiv, doi:10.1101/2021.01.31.426979 (Preprint) (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
	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.
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1/3	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
	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..
1/3	Details Source PDF Early treatment study Early treatment study
	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
	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 first day of use of 0.5% PVP-I nasal drops and discontinued its further use. However, none of the patients reported any serious side effects or allergic reaction to 0.5% PVP-I nasal drops and gargles. The 0.5% PVP-I gargles and nasal drops were used by healthcare workers about three to four times in a day for 5 months. None of them developed any COVID-19 symptoms.
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12/14	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
	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.
12/14	Details Source PDF Early treatment study Early treatment study
	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
	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.
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12/3	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
	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.
12/3	Details Source PDF Early treatment study Early treatment study
	Choudhury et al., Bioresearch Communications, Volume 7, Issue 1, January 2021 (Peer Reviewed)
	Effect of 1% Povidone Iodine Mouthwash/Gargle, Nasal and Eye Drop in COVID-19 patient
	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. risk of death, 88.2% lower, RR 0.12, p < 0.001, treatment 2 of 303 (0.7%), control 17 of 303 (5.6%). risk of hospitalization, 85.7% lower, RR 0.14, p = 0.004, treatment 2 of 303 (0.7%), control 14 of 303 (4.6%). risk of no virological cure, 96.2% lower, RR 0.04, p < 0.001, treatment 8 of 303 (2.6%), control 213 of 303 (70.3%), day 7.
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9/17	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
	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 ..
9/17	Details Source PDF In Vitro In Vitro
	Frank et al., JAMA Otolaryngol Head Neck Surg, doi:10.1001/jamaoto.2020.3053 (Peer Reviewed) (In Vitro)
	In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2
	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 nasal antiseptics tested.
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9/9	Early	Mohamed et al., medRxiv, doi:10.1101/2020.09.07.20180448 (Preprint)	viral+, ↓85.7%, p=0.17	Early viral cleerance among COVID-19 patients when gargling with povidone-iodine and essential oils: a pilot clinical trial
	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.
9/9	Details Source PDF Early treatment study Early treatment study
	Mohamed et al., medRxiv, doi:10.1101/2020.09.07.20180448 (Preprint)
	Early viral cleerance among COVID-19 patients when gargling with povidone-iodine and essential oils: a pilot clinical trial
	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. risk of no virological cure, 85.7% lower, RR 0.14, p = 0.17, treatment 0 of 5 (0.0%), control 3 of 5 (60.0%), continuity correction due to zero event, day 12.
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7/8	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
	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..
7/8	Details Source PDF In Vitro In Vitro
	Anderson et al., Infectious Diseases and Therapy, doi:10.1007/s40121-020-00316-3 (Peer Reviewed) (In Vitro)
	Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease
	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 0.45%)] achieved C 99.99% virucidal activity against SARS-CoV-2, corresponding to C 4 log10 reduction of virus titre, within 30s of contact.
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7/2	Early	Martínez Lamas et al., Oral Diseases, doi:doi.org/10.1111/odi.13526 (Peer Reviewed)		Is povidone iodine mouthwash effective against SARS‐CoV‐2? First in vivo tests
	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,..
7/2	Details Source PDF Early treatment study Early treatment study
	Martínez Lamas et al., Oral Diseases, doi:doi.org/10.1111/odi.13526 (Peer Reviewed)
	Is povidone iodine mouthwash effective against SARS‐CoV‐2? First in vivo tests
	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, which remained after 3 hours.
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6/26	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
	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..
6/26	Details Source PDF In Vitro In Vitro
	Hassandarvish et al., British Dental Journal volume, doi:10.1038/s41415-020-1794-1 (Peer Reviewed) (In Vitro)
	Povidone iodine gargle and mouthwash
	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 >4 log10 kill at 15 seconds and >5 log10 kill at 30 and 60 seconds in comparison to control was seen in both clean and dirty conditions.
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6/18	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
	Study of the use of PVP-I gargles and nasal drops before ENT appointments finding good tolerability.
6/18	Details Source PDF Early treatment study Early treatment study
	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
	Study of the use of PVP-I gargles and nasal drops before ENT appointments finding good tolerability.
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6/10	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
	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.
6/10	Details Source PDF Safety Safety
	Frank et al., Ear, Nose & Throat Journal, doi:10.1177/0145561320932318 (Peer Reviewed)
	Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era
	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.
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6/8	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
	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).
6/8	Details Source PDF In Vitro In Vitro
	Bidra et al., Journal of Prosthodontics, doi:10.1111/jopr.13209 (Peer Reviewed) (In Vitro)
	Rapid In‐Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) Using Povidone‐Iodine Oral Antiseptic Rinse
	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).
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5/7	PrEP	Mendoza et al., SSRN, doi:10.2139/ssrn.3589404 (Preprint)		Prevention of COVID-19 Infection with Povidone-Iodine
	Review of the antiviral efficacy of PVP-I and its potential use as a prophylactic on the oropharyngeal and nasopharyngeal mucosa for COVID-19.
5/7	Details Source PDF Pre-Exposure Prophylaxis study Pre-Exposure Prophylaxis study
	Mendoza et al., SSRN, doi:10.2139/ssrn.3589404 (Preprint)
	Prevention of COVID-19 Infection with Povidone-Iodine
	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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