Combined Nasal, Oropharyngeal Povidone Iodine Plus Glycyrrhizic Acid Sprays, Accelerate Clinical and Laboratory Recovery and Reduces Household Transmission of SARS-CoV-2: A Randomized Placebo-Controlled Clinical Trial

Abstract

The COVID-19 pandemic is still posing challenging health and economic problems. Effective broad-spectrum antiviral therapy is urgently needed for the control of early SARS-CoV-2 infection to limit its spread and mutations. In this randomized placebo-controlled clinical study, we tested the effects of intranasal and oropharyngeal delivery of a compound of povidone-iodine 0.5% and glycyrrhizic acid 2.5 mg/ml on the laboratory (PCR) and clinical recovery from SARS-CoV-2 patients and their household contacts. 353 patients suspected of having COVID-19 infection were screened by chest CT and nasopharyngeal swab tests (PCR). 200 patients were randomly allocated to two equal groups: treatment and placebo groups. Treatment accelerated the recovery of PCR on days 4, 7, and 10, as evidenced by PCR-positive patients (70, vs. 99%, 20 vs. 65%, 1 vs. 10%) in both the treated and placebo groups, respectively. Treatment enhanced the early recovery of symptoms [day 7.6 ± 2 (CI 7:8.3) vs. 8.9 ± 2 (CI 8.3:9.6)]. Treatment promoted early recovery of anosmia and ageusia [5.6 ± 1 (CI, 4.8:6.4) vs. 11 ± 3 days, (CI, 10.8:12)] in both the treated and control groups (P < 0.0001). There was a notable reduction in transmission of the virus among the household close contacts in the treatment group (4%) vs. 76% in the placebo group. Combined PVI-GA nasal and oropharyngeal spray accelerates both laboratory and clinical recovery of SARS-CoV-2 infected patients in the early phases of the disease and reduces the household spread of the virus; thus, it may play an important role in controlling coronavirus outbreaks.Clinical Trial Registrationhttps://pactr.samrc.ac.za, PACTR202101875903773.

Glycyrrhizin and boswellic acids, the golden nutraceuticals: multitargeting for treatment of mild–moderate COVID-19 and prevention of post-COVID cognitive impairment

“…(2020) Linlun-34th) DG + VC could reduce the incidence of new-onset complications in COVID-19 patients, and might influence the immune response in these patients. This results suggested that combined treatment of DG + VC is promising candidate for preventing the deterioration of COVID-19 patients Tan et al ( 2022 ) Intranasal and oropharyngeal delivery of povidone-iodine 0.5% and glycyrrhizic acid 2.5 mg/ml 200 patients Randomized-Blinded Controlled Study PACTR registry under the number PACTR202101875903773 Combined PVI-GA nasal and oropharyngeal spray accelerates both laboratory and clinical recovery of SARS-CoV-2-infected patients in the early phases of the disease and reduces the household spread of the virus Elsersy et al ( 2022 ) Viusid is natural product containing glycyrrhizinic acid 30 ml every 8 h for 21 days 60 hospitalized patients with mild to moderate symptoms of COVID-19 Randomized, open-label, controlled trial MBAL “Sveti Mina” (RCT001/P4/2020) Its use lead to faster recovery of the patients, decreasing of the hospital stay and milder course of the disease, with good safety and tolerability Petrov et al ( 2021 ) Aftogel (licorice extract) oral mucoadhesive patches 125 outpatient with positive real-time PCR Triple-blind randomized clinical trial RCT20181208041886N2 The patch is effective in the eradication of SARS-CoV-2, which has colonized the nasopharyngeal area. Hence, this drug product has the potential for evaluation as a prophylactic Pourahmad et al ( 2022 ) Inflawell Syrup (Boswellia extract formulation enriched for boswellic acids (BAs), 10 ml of syrup thrice daily (400 mg BAs) 47 hospitalized patients with moderate COVID-19 Randomized placebo-controlled double-blind clinical trial IRCT20170315033086N10.…”

Disinfection and decontamination in the context of SARS‐CoV‐2‐specific data

“…As an extension of applying topical disinfectants, several studies have assessed various topical mucosal anti‐SARS‐CoV‐2 agents 150,165,169,172,173 . Conceivably, such use could be of potential value for the prevention of both infection acquisition or secondary spread.…”

“…In a randomized trial of a silver nanoparticle suspension for oral and nasal rinsing and prevention, some early success was reported 184 . Another study showed a reduction in oral virus with cetylpyridinium chloride, but not povidone–iodine, and yet, others have suggested value in using povidone–iodine in a treatment format 169,173 . Ogun et al 172 found some reductions with hexetidine‐ and hydrogen peroxide‐containing products.…”

“…As an extension of applying topical disinfectants, several studies have assessed various topical mucosal anti‐SARS‐CoV‐2 agents. 150 , 165 , 169 , 172 , 173 Conceivably, such use could be of potential value for the prevention of both infection acquisition or secondary spread. For example, the focused use of these agents in dental offices to mitigate potential transmission has been considered to be useful.…”

“… 184 Another study showed a reduction in oral virus with cetylpyridinium chloride, but not povidone–iodine, and yet, others have suggested value in using povidone–iodine in a treatment format. 169 , 173 Ogun et al 172 found some reductions with hexetidine‐ and hydrogen peroxide‐containing products. Overall, and despite in vitro or in vivo efficacy, the actual contribution to practical disease prevention or reduction is not well established.…”