Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era

Frank, Samantha; Capriotti, Joseph; Brown, Seth M.; Tessema, Belachew

doi:10.1177/0145561320932318

Cited by 94 publications

(124 citation statements)

References 67 publications

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“…Even if some noncomplexed iodine were absorbed transmucosally, it would still be orders of magnitude less than the average total daily iodine intake for a healthy adult of 150 μg. 19 Use of 0.08% nasal PVP-I every other day for up to 7 weeks does not result in clinical thyroid disease. 20,21 Nevertheless, thyroid function testing should be considered when PVP-I is regularly administered to patients for more than 3 months.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

Frank

Brown

Capriotti³

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Research is needed to demonstrate the efficacy of nasal povidone-iodine (PVP-I) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE To evaluate the in vitro efficacy of PVP-I nasal antiseptic for the inactivation of SARS-CoV-2 at clinically significant contact times of 15 and 30 seconds. INTERVENTIONS The SARS-CoV-2, USA-WA1/2020 strain, virus stock was tested against nasal antiseptic solutions consisting of aqueous PVP-I as the sole active ingredient. Povidone-iodine was tested at diluted concentrations of 0.5%, 1.25%, and 2.5% and compared with controls. The test solutions and virus were incubated at mean (SD) room temperature of 22 (2)°C for time periods of 15 and 30 seconds. DESIGN AND SETTING This controlled in vitro laboratory research study used 3 different concentrations of study solution and ethanol, 70%, as a positive control on test media infected with SARS-CoV-2. Test media without virus were added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol, 70%, was tested in parallel as a positive control and water only as a negative control. MAIN OUTCOMES AND MEASURES The primary study outcome measurement was the log reduction value after 15 seconds and 30 seconds of given treatment. Surviving virus from each sample was quantified by standard end point dilution assay, and the log reduction value of each compound was compared with the negative (water) control. RESULTS Povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact as measured by log reduction value of greater than 3 log 10 of the 50% cell culture infectious dose of the virus. The ethanol, 70%, positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact. The nasal antiseptics tested performed better than the standard positive control routinely used for in vitro assessment of anti-SARS-CoV-2 agents at a contact time of 15 seconds. No cytotoxic effects on cells were observed after contact with each of the nasal antiseptics tested. CONCLUSIONS AND RELEVANCE Povidone-iodine nasal antiseptic solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 at contact times as short as 15 seconds. Intranasal use of PVP-I has demonstrated safety at concentrations of 1.25% and below and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment.

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Section: Discussionmentioning

confidence: 99%

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

Frank

Brown

Capriotti³

et al. 2020

JAMA Otolaryngol Head Neck Surg

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“…7,12,13 Recent articles have discussed the importance of preprocedural oral antiseptic rinses for use on patients as well as dental and medical professionals, in order to reduce the risk of transmission associated with viral shedding from asymptomatic individuals. 6,7,14 A variety of oral antiseptic rinses have been suggested in recent literature for preprocedural use to reduce viral transmission. 12 Oral rinses ranging from chlorhexidine gluconate, ethanol, essential oils, povidone-iodine (PVP-I), hydrogen peroxide (H 2 O 2 ) chlorinated water, hypertonic saline, bioflavonoids, cyclodextrins, cetylpyridinium chloride have been recommended.…”

mentioning

confidence: 99%

Comparison of In Vitro Inactivation of SARS CoV‐2 with Hydrogen Peroxide and Povidone‐Iodine Oral Antiseptic Rinses

Bidra

Pelletier

Westover

et al. 2020

Journal of Prosthodontics

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155

167

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Purpose To evaluate the in vitro inactivation of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) with hydrogen peroxide (H2O2) and povidone‐iodine (PVP‐I) oral antiseptic rinses at clinically recommended concentrations and contact times. Materials and Methods SARS‐CoV‐2, USA‐WA1/2020 strain virus stock was prepared prior to testing by growing in Vero 76 cells. The culture media for prepared virus stock was minimum essential medium (MEM) with 2% fetal bovine serum (FBS) and 50 µg/mL gentamicin. Test compounds consisting of PVP‐I oral rinse solutions and H2O2 aqueous solutions were mixed directly with the virus solution so that the final concentration was 50% of the test compound and 50% of the virus solution. Thus PVP‐I was tested at concentrations of 0.5%, 1.25%, and 1.5%, and H2O2 was tested at 3% and 1.5% concentrations to represent clinically recommended concentrations. Ethanol and water were evaluated in parallel as standard positive and negative controls. All samples were tested at contact periods of 15 seconds and 30 seconds. Surviving virus from each sample was then quantified by standard end‐point dilution assay and the log reduction value of each compound compared to the negative control was calculated. Results After the 15‐second and 30‐second contact times, PVP‐I oral antiseptic rinse at all 3 concentrations of 0.5%, 1.25%, and 1.5% completely inactivated SARS‐CoV‐2. The H2O2 solutions at concentrations of 1.5% and 3.0% showed minimal viricidal activity after 15 seconds and 30 seconds of contact time. Conclusions SARS‐CoV‐2 virus was completely inactivated by PVP‐I oral antiseptic rinse in vitro, at the lowest concentration of 0.5 % and at the lowest contact time of 15 seconds. Hydrogen peroxide at the recommended oral rinse concentrations of 1.5% and 3.0% was minimally effective as a viricidal agent after contact times as long as 30 seconds. Therefore, preprocedural rinsing with diluted PVP‐I in the range of 0.5% to 1.5% may be preferred over hydrogen peroxide during the COVID‐19 pandemic.

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“…The anosmia may be managed by nasal lavages, oral corticosteroids, and olfactory training. 12,13 Future prospective immunological studies are needed to confirm our observations and to specify the rate of reinfection according to the initial COVID-19 clinical presentation and stages.…”

mentioning

confidence: 79%

COVID-19 Reinfection and Second Episodes of Olfactory and Gustatory Dysfunctions: Report of First Cases

Lechien¹,

Chiesa‐Estomba

Vaira

et al. 2020

Ear Nose Throat J

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The pandemic of coronavirus disease 2019 (COVID-19) is associated with a significant number of deaths worldwide. Currently, there is an increase of new cases of COVID-19 in Europe, leading to many hospitalizations of patients. 1 According to the high rate of virus mutation, 2 and the prevalence of patients without postinfection antibodies, 3 many questions rise about the risk of reinfection, especially in anosmic patients who may have less antibodies than nonanosmic individuals. 4 In this letter, we report 2 cases of patients who developed a second COVID-19, which was associated with a second episode of both loss of smell and taste.A 42-year-old Parisian male developed moderate form of COVID-19 in March with dyspnea, fever, headache, diarrhea, and abdominal pain as main symptoms. The patient was homemanaged and developed ageusia and total loss of smell at the end of the disease. Total loss of smell was characterized by a Sniffin' Sticks test of 0/16 (Medisense). He had no nasal symptoms. Nasal swab was not performed because a shortage of tests (reverse transcription polymerase chain reaction [RT-PCR]) in France at this time. Serology testing was realized 2 months after the infection and reported mild level of anti-SARS-CoV-2 immunoglobulin G (IgG; 7.31). Patient benefited from 2-month olfactory training and reported that he progressively recovered smell (June). Gustatory function, defined as impairment of salty, sweet, bitter, and sour, recovered 1-month postinfection. In the end of July, patient had a normal olfactory function. In August, the patient traveled in a region characterized by a high rate of new cases of COVID-19 (isolated cluster region) and developed fever, nasal burning, and a new total loss of smell and taste. He had no additional symptoms. Patient was addressed in our Department in October 5, 2020. The clinical examination did not report edema in the olfactory clefts, and Sniffin' Sticks tests (Medisense) revealed anosmia (7/16). A second serology using similar method that the first reported an increase of the level of anti-SARS-CoV-2 IgG (70.34), confirming the reinfection.

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Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era

Cited by 94 publications

References 67 publications

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

Comparison of In Vitro Inactivation of SARS CoV‐2 with Hydrogen Peroxide and Povidone‐Iodine Oral Antiseptic Rinses

COVID-19 Reinfection and Second Episodes of Olfactory and Gustatory Dysfunctions: Report of First Cases

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