Virucidal effect of povidone iodine on COVID-19 in the nasopharynx: an open-label randomized clinical trial

Abstract

Povidone-iodine (PVP-I) is a time-tested antiseptic agent with excellent virucidal (99.99%) properties. Repurposing it against coronavirus disease-19 (COVID-19) is a relatively newer concept and has been sparsely tested in vivo. The most common route of entry of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the nasopharynx. Averting colonization of the virus could be one of the best options to reduce the incidence of infection. PVP-I gargle and mouthwash were found to be effective in vitro rapid inactivation against SARS-CoV-2 on a smaller scale (Hassandarvish et al. in BDJ 1-4, 2020, Pelletier et al. in ENTJ 1-5, 2020. However, efficacy in humans is lacking. To assess the virucidal effect of PVP-I against SARS-CoV-2 located in the nasopharynx was the objective of this parallel armed randomized clinical trial. We screened all RT-PCR-confirmed COVID-19 cases aged 18 years and above with symptoms. Written informed consent was obtained before randomization. Nasopharyngeal clearance of SARS-CoV-2 was tested after single time application of PVP-I nasal irrigation (NI) at diluted concentrations of .4%, .5% and .6% and PVP-I nasal spray (NS) at diluted concentrations of .5% and .6%. All groups were compared to the corresponding controls (distilled water). The primary outcome was viral clearance in a repeat RT-PCR (qualitative), and the secondary outcome was the number of adverse events. Final data analysis was performed using the statistical software SPSS (Version 20). A total of 189 confirmed COVID-19 cases were randomized into seven groups: 27 patients in each group. Of all, 159 (84.1%) were male, and 30 (15.9%) were female. We observed a statistically significant proportion of nasopharyngeal clearance with all strengths of PVP-I NI and PVP-I NS compared to the corresponding controls. Additionally, 0.5% NI was significantly better than 0.5% NS for viral clearance (p = 0.018) and had the highest nasopharyngeal clearance among all

Renessans Helps in Early Clearance of SARS-CoV-2: In-Vivo Activity of the Iodine Complex in Rhesus macaque

“…Iodine compounds have been previously reported to bring about changes in the viral coat by modifying histidine and tyrosine amino acids leading to impairment of the attachment phase [ 31 ]. The present findings are consistent with the studies performed on MERS coronavirus and SARS-CoV-2 where researchers found iodine compounds to be clearing the viral load in cell-culture suspension assays, oral cavity, skin surface, and nasopharyngeal wash [ 23 , 24 , 32 , 33 , 34 ]. The present study’s findings may pave the way for the repurposing of Renessans, which is already approved for the treatment of ulcerative conditions (European Patent Specification 2011).…”

“…A concentration containing 1% active ingredient showed complete virucidal effect on salivary secretions [ 24 ]. The results of virucidal activity remained promising when the formulation was tested via nasal irrigation for nasopharyngeal wash as well [ 33 ]. Apart from other formulations of iodine, Renessans composition has also been tested for antiviral potential for influenza virus and hepatitis C virus [ 21 , 35 ].…”

Repurposing povidone-iodine to reduce the risk of SARS-CoV-2 infection and transmission: a narrative review

“…Other than this preventive trial [ 13 ], most studies that examined the efficacy of povidone-iodine enrolled cohorts ranging from 4 to 189 participants [ 48 , 52 ]. Some of these studies measured virus load from nasopharyngeal samples [ 13 , 44 , 47 , 49 ], while others measured virus load in saliva [ 48 , 45 , 51 ]. As few studies correlated their cycle threshold (Ct) values with virus load, data from existing studies cannot be pooled to reliably compare the overall effects of povidone-iodine on virus load.…”

“…In a clinical trial involving 735 participants who received povidone-iodine (0.45% concentration), none reported local irritant effects of povidone-iodine despite applying povidone iodine throat spray 3 times daily to the throat for 42 d [ 13 ]. Although largely self-limited nasal tingling has been reported in some studies [ 44 , 47 , 68 ], data from one clinical trial did not observe alterations in nasal function or detectable damage to the ciliated epithelium [ 69 ].…”

Mouth rinses against SARS-CoV-2

“…Povidone iodine (PVP-I) can be safely used in the nose at concentrations up to 1.25% and in the mouth at concentrations up to 2.5% for a maximum of 5 months [24] . PVP-I is a proven antiseptic agent with excellent virucidal properties (99.99%) [25] , dilute solutions of PVP-I have historically been used in Asia to treat upper respiratory tract infections [26] . Antiseptic nasal and oral PVP-I solutions are effective in inactivating SARS-CoV-2 at a variety of concentrations after exposure times of 60 seconds [27,28] .…”