Dentistry: Povidone Iodine (PVP-I) Prevents and Treats Early Phases of COVID-19

Povidone Iodine (PVP-I) can be used in the form of mouthwash and nasal spray (especially in Dental and ENT settings) to prevent the spread of the SARS-CoV-2 virus, to reduce cross-infection and to manage patients at the early stage of disease.  

Povidone iodine, known commonly as Betadine is used widely in medicine and dentistry as an effective topical antiseptic for over a century.  It is the broadest spectrum antiseptic and is effective against a range of microbes such bacteria (gram-positive and gram negative), spores of bacteria, protozoa, fungi and several viruses, including H1N1 influenza virus ¹.  

Duo to the extraordinary situation presented by COVID-19, range of pharmaceutical strategies including repurposing of existing drugs are being tried to prevent and treat this disease ⁷. Could povidone iodine, which is known to be effective against some viruses including SARS-CoV  be used as an effective antiseptic against SARS-CoV-2 infection as well?  

Based on earlier report of effectiveness of povidone iodine against SARS-CoV  virus ², Challacombe et al proposed using nasal spray and mouthwash/gargle of povidone iodine to control the spread of novel coronavirus from dental patients to healthcare workers ³. Soon, other researchers confirmed effectiveness of PVP-1 against SARS-CoV-2 virus in an in vitro study ^4,5 and suggested use of PVP-I gargle and mouthwash in dental practice ⁴ and ENT practice ⁶ to minimise risk of spread of infection.  

Currently, several clinical trials are in progress at various stages to assess efficacy of povidone iodine in the form of mouthwash and nasal spray in prevention and control of COVID-19 ⁷. Few have been completed, and they show very encouraging results. One preliminary study reports 100% viral clearance for 1% povidone iodine in a small group of confirmed stage 1 COVID-19 patients. Further larger studies are required to confirm the benefits of PVP-1 gargle for patients at different stages of COVID-19 ⁸. In another completed study, use of 1% povidone iodine considerably reduced mortality and morbidity among COVID-19 patients ⁹.  

Povidone iodine (PVP-1) mouthwash and nasal spray is simple and very cost-effective intervention for limiting spread of and managing early stage COVID-19 patients.  

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References:  

1. Lachapelle, Castel, Casado et al.2013. Antiseptics in the era of bacterial resistance: a focus on povidone iodine. Clin. Pract. (2013) 10(5), 579–592. Available https://www.openaccessjournals.com/articles/antiseptics-in-the-era-of-bacterial-resistance-a-focus-on-povidone-iodine.pdf Accessed on 27 January 2021. 

2. Kariwa H, Fujii N, Takashima I. 2006. Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions and chemical reagents. Dermatology 2006; 212 Suppl: 119-123. DOI: https://doi.org/10.1159/000089211  

3. Challacombe, S., Kirk-Bayley, J., Sunkaraneni, V. et al. Povidone iodine. Br Dent J 228, 656–657 (2020). Published 08 May 2020 DOI:https://doi.org/10.1038/s41415-020-1589-4 

4. Hassandarvish, P., Tiong, V., Sazaly, A. et al. Povidone iodine gargle and mouthwash. Br Dent J 228, 900 (2020). Published: 26 June 2020. DOI: https://doi.org/10.1038/s41415-020-1794-1 

5. Zoltán K., 2020. In Vitro Efficacy of “Essential Iodine Drops” Against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). Preprint bioRxiv. Posted 10 November 2020. DOI: https://doi.org/10.1101/2020.11.07.370726 

6. Khan MM, Parab SR and Paranjape M., 2020. Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic. American Journal of Otolaryngology, Volume 41, Issue 5, 2020, 102618, DOI: https://doi.org/10.1016/j.amjoto.2020.102618 

7. Scarabel L., et al., 2021. Pharmacological strategies to prevent SARS-CoV-2 infection and to treat the early phases of COVID-19 disease. International Journal of Infectious Diseases. Available online 18 January 2021. DOI: https://doi.org/10.1016/j.ijid.2021.01.035 

8. Mohamed NA., Baharom N., 2020. Early Viral Clearance Among Covid-19 Patients When Gargling with Povidone-iodine And Essential Oils: A Pilot Clinical Trial. Preprint. medRxiv. Posted 09 September 2020. DOI: https://doi.org/10.1101/2020.09.07.20180448  

9. Choudhury MIM, Shabnam N., et al 2021. “Effect of 1% Povidone Iodine Mouthwash/Gargle, Nasal and Eye Drop in COVID-19 patient”, Bioresearch Communications-(BRC), 7(1), pp. 919-923. Available at: http://www.bioresearchcommunications.com/index.php/brc/article/view/176  (Accessed: 27January2021). 

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