Efficacy of Cetylpyridinium Chloride mouthwash against SARS‐CoV‐2: A systematic review of randomized controlled trials

Abstract

Introduction COVID‐19 is a transmissible respiratory and multisystem disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Viral transmission occurs mainly through the spread of salivary droplets or aerosol from an infected subject. Studies suggest that salivary viral load is correlated with disease severity and probability of transmission. Cetylpyridinium chloride mouthwash has been found to be effective in reducing salivary viral load. The aim of this systematic review of randomized controlled trials is to evaluate the efficacy of the mouthwash ingredient cetylpyridinium chloride on salivary viral load in SARS‐CoV‐2 infection. Methods Randomized controlled trials comparing cetylpyridinium chloride mouthwash with placebo and other mouthwash ingredients in SARS‐CoV‐2 positive individuals were identified and evaluated. Results Six studies with a total of 301 patients that met the inclusion criteria were included. The studies reported the efficacy of cetylpyridinium chloride mouthwashes in reduction on SARS‐CoV‐2 salivary viral load compared to placebo and other mouthwash ingredients. Conclusion Mouthwashes containing cetylpyridinium chloride are effective against salivary viral load of SARS‐CoV‐2 in vivo. There is also the possibility that the use of mouthwash containing cetylpyridinium chloride in SARS‐CoV‐2 positive subjects could reduce transmissibility and severity of COVID‐19.

Cetylpyridinium chloride and chlorhexidine show antiviral activity against Influenza A virus and Respiratory Syncytial virus in vitro

“…All in all, our results confirm the antiviral properties of CPC and CHX against IAV and include RSV as a susceptible microorganism to these two compounds. Given these results, the data available in the literature [5,8,9,11,[13][14][15][19][20][21]34], and the mechanisms of action of both CPC and CHX [10,22,[35][36][37][38] we could expect similar results for other enveloped respiratory viruses.…”

“…Additionally, CPC has demonstrated antiviral activity against some enveloped viruses, including common human coronaviruses [12], Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV 2) [13][14][15][16], Middle East Respiratory Syndrome virus (MERS) [17,18], and influenza virus [19]. Furthermore, mouthwash formulations containing CPC reduced cold symptoms in randomized placebo-controlled double-blind trials [20,21]. The positively charged "head" on CPC interacts with negatively charged lipids on the surface of biological membranes, both of viral or bacterial origin.…”

An exploratory study of drug concentration and inhibitory effect of cetylpyridinium chloride buccal tablets on SARS‐CoV‐2 infection among 10 Chinese subjects

“…Tarrago-Gil et al initiated a clinical trial to detect SARS-CoV-2 in saliva of COVID-19 patients 2 h after using 0.07% CPC mouthwash or placebo, and the results showed that virus lysis in saliva of patients was significantly increased after CPC mouthwash intervention [20]. D'Amico et al conducted a systematic review of 6 randomized controlled studies involving 301 participants, results of which suggested that, compared to the group of placebo and other mouthwash ingredients, CPC suggested favorable effectiveness [21]. Besides, this systematic review also indicated that CPC alone can eradicate SARS-CoV-2, while some substances of mouthwash product, such as benzoate, possibly even blunt the CPC effects.…”

Do Oral Antiseptics Affect the Force Degradation of Elastomeric Chains?

“…Essential oils containing mouthwashes due to their antimicrobial and anti-inflammatory properties are commonly used since their usage is not time limited [8]. Cetylpyridinium chloricum (CPC) containing mouth rinses gained popularity recently due to its effectiveness during the COVID-19 pandemic [13]. Its adjunctive use in dentistry had limited effects in controlling plaque accumulation and gingivitis levels, with no adverse microbiological or tissue effects [14].…”