Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic

Abstract

SARS CoV 2 is very much homologous in structure to SARS CoV. Review of literature suggests the in-vitro virucidal action of povidone iodine in SARS CoV and MERS. The oropharynx and nasopharynx are target sites of SARS CoV 2. A significant proportion of COVID 19 sufferers are asymptomatic, but shedding these viral particles, PVP-I has been shown to be a safe therapy when used as a mouthwash or taken nasally or used during ophthalmic surgeries. Aims:1. To propose the use of 0.5% Povidone iodine gargles and nasal drops as prerequisite for office based nose and throat examination and procedures during COVID 19 pandemic. 2. To assess tolerability of 0.5% PVP-I in patients and in healthcare workers. Materials and methods: 0.5% PVP-I solution is prepared from commercially available 10% PVP-I solution.Patients were instructed to put 0.5% PVP-I drops in nose and rinse mouth with gargle prior examinations for 30 s. For endoscopic procedure (nasal and throat) nasal douching and gargling to be started one day prior. Douching and rinsing to be repeated just before procedures. Nasal packing with 0.5% PVP-I along with 4% xylocaine/adrenaline solution, tolerability and any allergic reaction noted. Results: The patient and health care workers tolerated the 0.5%. No allergy was noted. Conclusion:We propose the use of 0.5% PVP-I in healthcare workers and their patients to minimise the risk of spread of the disease in addition to the recommended PPE.

Efficacy of Povidone-Iodine Nasal and Oral Antiseptic Preparations Against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2)

“…This helps to support the recommendations for nasal and oral PVP-I use within the clinical community. 11,12…”

Challenges in the management of ENT foreign bodies during COVID-19 Pandemic - Experience at a tertiary care centre.

“…The human saliva is the next highest region with 1.2 × 10 8 infective copies per ml. These areas are main reservoirs to seed the lower airway and also contribute to aerosolized transmission of the virus [13]. It is important to categorise the procedures according to their degree of urgency.…”

“…Pre-operatively all patients were given Povidone-iodine (PVP-I) 0•5% PVP-I solution prepared by diluting (1 ml of 10% PVP-I in 20 ml of sterile water or puri ed water or 1 ml of 5% PVP-I in 10 ml of sterile water or puri ed water).It was administered in a dose of 4-5 drops into each nostril 10 min prior to examination. Before inducing, nasal pack with PVP was used and nasal douching was done 2 times prior to the day of procedure [13]. Nasal irrigation constituted of 240 mL of 0.4% PVP-I solution (dilution of 10 mL of commercially available 10% aqueous PVP-I into 240 mL of normal saline with a sinus rinse delivery bottle) [14].…”

“…For Oral/oropharyngeal wash 10 ml of the 0•5% PVP-I solution was then introduced into the oral cavity and used as a mouthwash. It was ensured the solution was distributed throughout the oral cavity for 30 seconds and then gently gargled for another 30 seconds before spitting out [13].…”

Antiviral mouthwashes: possible benefit for COVID-19 with evidence-based approach

“…A hospital study on the COVID-19 crisis recommended the use of this mouthwash for patients and staff of the health department who are in direct contact with COVID-19 patients [49].…”