Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study

Abstract

Background: Topical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation. However, it is not approved for mucosal application in Japan. The aims of this study were to investigate if topical povidone iodine (i) inhibits bacterial growth and (ii) disrupts the balance of the oral microbiota. Methods: This randomized controlled clinical trial included 23 patients who underwent mechanical ventilation in the intensive care unit. The patients were divided randomly into two groups: the intervention group (n = 16) and the control group (n = 7). All patients received oral cleaning with 3% hydrogen peroxide, followed by irrigation with tap water. The patients in the intervention group received 10% povidone iodine applied topically to the oral cavity. The concentration of total bacteria in the oropharyngeal fluid were determined before, immediately after, 1 h, 2 h, and 3 h after oral care using the Rapid Oral Bacteria Quantification System, which is based on dielectrophoresis and impedance measurements. The number of streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans before, immediately after, 1 h, and 3 h after oral care were estimated based on real-time polymerase chain reaction data. Results: After irrigation of the oral cavity, the number of bacteria decreased, but increased again at 1 h after oral care in the control group; however, in the intervention group, the concentration of bacteria was significantly lower than that in the control group at 1 hour (p = 0.009), 2 h (p = 0.001), and 3 h (p = 0.001) after oral care. The growth of all bacterial species tested was inhibited in the intervention group at 3 h after oral care, suggesting that povidone iodine did not disturb the balance of the oral microbiota.Conclusions: Topical application of povidone iodine after cleaning and irrigation of the oral cavity inhibited bacterial growth in the oropharyngeal fluid of patients on mechanical ventilation while not disrupting the balance of the oral microbiota.

Use of mouthwashes against COVID-19 in dentistry

“…Its antimicrobial action occurs after free iodine dissociates from polyvinylpyrrolidone, then iodine rapidly penetrates microbes to disrupt proteins and oxidises nucleic acid structures causing microbial death. 38 , 39 Previously studies have shown that PVP-I has higher virucidal activity than other commonly used antiseptic agents, including CHX and benzalkonium chloride. 40 It is safe, reporting a prevalence of 0.4% allergy cases, 41 does not produce tooth or tongue discolouration or taste disturbances 42 and, unlike alcohol-based products, can be used when using electrocautery.…”

Topical preparations to reduce SARS‐CoV‐2 aerosolization in head and neck mucosal surgery

“…From a safety perspective, it has been tolerated for use in the upper airway as has been demonstrated in numerous human studies. In the oral cavity and oropharynx it has been used safely at a range of doses from 1% to 10% for oropharyngeal infection prophylaxis, mucositis, and prevention of ventilator‐associated pneumonia 20‐24 . Commercial over‐the‐counter oral mouthrinse formulations are typically of 1% PVP‐I.…”

Povidone–iodine solution: A potential antiseptic to minimize the risk of COVID-19? A narrative review

“…In the oral mucosa, it has been used safely at doses from 1% to 10% for infection prophylaxis and prevention in upper respiratory tract surgical procedures. [ 24 ] Typically, commercial over‐the‐counter oral mouth rinse formulations are of 1% PVP‐I. [ 25 ]…”