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In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial

Elzein et al., Journal of Evidence Based Dental Practice, doi:10.1016/j.jebdp.2021.101584 (date from preprint)

Mar 2021

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PVP-I for COVID-19

12th treatment shown to reduce risk in February 2021

^*, now known with p = 0.000000004 from 21 studies.

Lower risk for mortality, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,100+ studies for 60+ treatments. c19early.org

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), compared to no significant difference for water.

Analysis of short-term changes in viral load using PCR may not detect effective treatments because PCR is unable to differentiate between intact infectious virus and non-infectious or destroyed virus particles. For example Alemany, Tarragó‐Gil perform RCTs with cetylpyridinium chloride (CPC) mouthwash that show no difference in PCR viral load, however there was significantly increased detection of SARS-CoV-2 nucleocapsid protein, indicating viral lysis. CPC inactivates SARS-CoV-2 by degrading its membrane, exposing the nucleocapsid of the virus. To better estimate changes in viral load and infectivity, methods like viral culture or antigen detection that can differentiate intact vs. degraded virus are preferred.

This study is excluded in the after exclusion results of meta analysis: study only provides short-term viral load results.

1. Alemany et al., Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial, Journal of Dental Research, doi:10.1177/00220345221102310.sagepub.com, doi.org.

2. Tarragó‐Gil et al., Randomized clinical trial to assess the impact of oral intervention with cetylpyridinium chloride to reduce salivary SARS‐CoV‐2 viral load, Journal of Clinical Periodontology, doi:10.1111/jcpe.13746.wiley.com, doi.org.

Important missing comments or errors? Let us know.

Study covers chlorhexidine and povidone-iodine.

relative improvement in Ct value, 88.8% better, RR 0.11, p < 0.05, treatment 25, control 9.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Elzein et al., 17 Mar 2021, Double Blind Randomized Controlled Trial, Lebanon, peer-reviewed, 7 authors, study period June 2020 - September 2020.

This Paper Povidone-Iod..All

In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial

Rola Elzein, Fadi Abdel-Sater, Soha Fakhreddine, Pierre Abi Hanna, Rita Feghali, Hassan Hamad, Fouad Ayoub

Journal of Evidence Based Dental Practice, doi:10.1016/j.jebdp.2021.101584

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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