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

Abstract

Introduction: Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the global pandemic of coronavirus disease 2019 (COVID-19). From the first reported cases in December 2019, the virus has spread to over 4 million people worldwide. Human-to-human transmission occurs mainly through the aerosolization of respiratory droplets. Transmission also occurs through contact with contaminated surfaces and other fomites. Improved antisepsis of human and nonhuman surfaces has been identified as a key feature of transmission reduction. There are no previous studies of povidone iodine (PVP-I) against SARS-CoV-2. This study evaluated nasal and oral antiseptic formulations of PVP-I for virucidal activity against SARS-CoV-2. This is the first report on the efficacy of PVP-I against the virus that causes COVID-19. Methods: Povidone iodine nasal antiseptic formulations and PVP-I oral rinse antiseptic formulations from 1% to 5% concentrations as well as controls were studied for virucidal efficacy against the SARS-CoV-2. Test compounds were evaluated for ability to inactivate SARS-CoV-2 as measured in a virucidal assay. SARS-CoV-2 was exposed directly to the test compound for 60 seconds, compounds were then neutralized, and surviving virus was quantified. Results: All concentrations of nasal antiseptics and oral rinse antiseptics evaluated completely inactivated the SARS-CoV-2. Conclusions: Nasal and oral PVP-I antiseptic solutions are effective at inactivating the SARS-CoV-2 at a variety of concentrations after 60-second exposure times. The formulations tested may help to reduce the transmission of SARS-CoV-2 if used for nasal decontamination, oral decontamination, or surface decontamination in known or suspected cases of COVID-19.

Innovations in otorhinolaryngology in the age of COVID‐19: A systematic literature review

“…In a literature review, Parhar et al 22 found that 0.23% to 7% Povidone-iodine (PVP-I) solutions were effective in reducing viral loads of the coronaviruses that cause severe acute respiratory syndrome (SARS-CoV1) and Middle East Respiratory Syndrome (MERS-CoV). This has been confirmed more recently by Pelletier et al 23 when they directly evaluated nasal and oral antiseptic formulations of PVP-I for virucidal activity against SARS-CoV-2. They found that a variety of concentrations completely inactivated the virus at a 60 second exposure time.…”

“…They found that a variety of concentrations completely inactivated the virus at a 60 second exposure time. 23 Mady et al 24 also propose a strategy utilizing PVP-I as both a nasal irrigation and an oral/oropharyngeal wash for surgical and non-surgical patients with suspected or confirmed COVID-19 infection, as well as for healthcare providers prior to and after contact with suspected/confirmed COVID-19 positive patients. PVP-I has been directly compared to hydrogen peroxide, another virucidal topic agents, and has been found to be more effective at a variety of dilutions.…”

“… 24 These safe to use and readily available PVP-I solutions may reduce the risk of COVID-19 aerosolization and transmission in upper airway mucosal surgery. 22 , 23 , 24 , 25 , 26 , 27 …”

“… PVP-I has superior anti-virucidal properties against SARS-CoV-2 than hydrogen peroxide does. Pelletier JS, Tessema B, Frank S, et al 23 Preclinical evaluation of intervention: proof-of-concept Level 4 (case-control) Risk of Bias: Low(authors disclose conflicting interests) Mady LJ, Kubik MW, Baddour K, et al 24 Technical report of intervention (Letter to the editor) Level 5 (mechanism-based reasoning) Risk of Bias: N/A Bidra AS, Pelletier JS, Westover JB, et al 25 Preclinical evaluation of intervention: comparative Level 4 (case-control) Risk of Bias: Low Khan MM, Parab SR. 26 Technical report of intervention Level 5 (mechanism-based reasoning) Risk of Bias: N/A Nasal irrigations have the potential to eliminate viral particles in the nasopharynx. Farrell NF, Klatt-Cromwell C, Schneider JS.…”

Virucidal gargling and virucidal nasal spray

“…When PVP-iodine-based mouthrinses and nasal sprays were tested, PVP-iodine was reliably inactivated at ≥1% SARS-CoV-2 [ 27 ]. Since a 1.25% PVP-iodine solution can be produced in any pharmacy in accordance with NRF 15.13 [ 28 ], filling in spray bottles is possible as long as no commercial product is available in Germany.…”