Povidone Iodine Nasal Spray and COVID-19: Studies Conclude that Povidone Iodine Might Be Helpful in Improving Outcomes

By Dr Frank Yap, M.D. -

Povidone Iodine has been well documented as one of the most effective of all antimicrobials available. Hospitals and medical facilities worldwide use povidone-iodine (Betadine) as a standard of care in infection control, even though it contains very small amounts of Iodine. Betadine (PVP-1) has been in commercial use since 1955 and is on the World Health Organization’s list of essential medicines.

Source: https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/essential-medicines-lists

PVP-1 contains 31,600 ppm of iodine compounds, but it is only I2 that is the biocidal species responsible for its antimicrobial activity. I2 occurs in trace quantities of 2–3 ppm, but even at these levels, it is considered the best at destroying bacteria, viruses, and fungi. All the other aspects of PVP-1 only contribute to its toxicity, staining, and unpleasant taste.

For more than 50 years, PVP-1 has been used as an essential medicine in hospitals and health-care clinics as a scrub for surgeries as well as hand disinfection for surgical personnel. It has been an integral antiseptic as a wound disinfectant.

PVP-1 has also been shown to be highly effective in the treatment of periodontal disease. Jørgen Slots wrote that it is a valuable antiseptic in its treatment of periodontal disease and a variety of other oral infections. His research has shown that it kills all periodontal pathogens in vitro within 15–20 seconds. Slots also says that it exhibits a wide viricidal spectrum, covering both nonenveloped and enveloped viruses, including the periodontopathogenic cytomegalovirus.

Source:10.1111/j.1600-0757.2011.00429.x

Fortunately, there is a new generation of recently patented iodine-based antiseptics that overcome the negative side effects of PVP-1. A new aqueous formulation with 100 times more I2 than contained in PVP-1 is now available, and the nonbiocidal content has been reduced from 31,600 ppm to a few hundred ppm. This new formulation increases its effectiveness, safety, and shelf life, while also reducing staining, toxicity, bad taste, and potential irritancy. It is now available in mouthrinses, concentrates, nasal sprays, and hand sanitizers offered by IoTech International.

Source: IoTech International, Boca Raton, Florida   

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David Derry, MD, PhD, author of Iodine: The Forgotten Weapon Against Influenza Viruses, says that after 30 million people were killed by the 1918 Spanish flu pandemic, there was much research funded to discover which agents were effective against influenza viruses. Washing hands with a standard 70% alcohol is effective against most bacteria, but it was shown to have little effect against viruses. Masks used in 1918 showed barely detectable benefits in holding back the influenza viruses. More than 25 years of research has proven that iodine was the most effective agent. Aerosol iodine was found to kill viruses in sprayed mists. Oral preparations were also shown to be effective, along with handwashing using mild iodine solutions. Derry said research showed that iodine incorporated into masks, aerosols, and oral preparations could all help kill influenza viruses. His conclusions state that free iodine (molecular iodine) is the best way to combat an influenza outbreak.

Source:10.1002/jps.3030440315

In a study by the Institute for Antiviral Research at Utah State University, it was demonstrated that the COVID-19 virus can be completely inactivated with a 30-second exposure to a 100 ppm molecular iodine (I2) mouthrinse.1 This in vitro study opens the door for further research and the need to review past and current research about the efficacy of I2 as an antimicrobial therapeutic agent. Molecular iodine is the only species of iodine that is antimicrobial.

Source: https://pubchem.ncbi.nlm.nih.gov/patent/US2018360048


 

betadine and COVID-19
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Nobel prize winner Sir Frank Macfarlane Burnet and Joyce D. Stone showed that when mice were exposed to lethal doses of influenza, a control group with iodine rubbed on their snouts survived while the unprotected mice died. They suggested that “it may be worth considering iodine vapor as a practical means of limiting indoor infection during an influenza epidemic.”

Research has continued to show iodine to be effective against viruses. In 1943, Dunham and MacNeal demonstrated that vaccinia virus could be killed with a 3% tincture of iodine. In 1955, Louis Gershenfeld found that tincture of iodine was the most the effective antiseptic found to quickly destroy the poliovirus. He reported that he developed a mouthwash capable of killing the virus using concentrations of free iodine. These landmark studies and others demonstrate iodine’s efficacy as an antiviral.9

Source: Iodine: the forgotten weapon against influenza viruses

Recently, much research has been published on the effects PVP-1 has on the COVID-19 virus and its rapid inactivation upon exposure. Multiple studies have shown that povidone-iodine with its small amount of I2 has quick and effective antiviral qualities and is sufficient to be used as a proactive preventive therapy against COVID-19. It has many uses including hand and skin sanitizing, oral rinsing, throat spraying, gargling, and nasal spraying to inactivate the virus.

Sources:

  1. doi:10.1007/s40121-018-0200-7
  2. doi:10.1186/s12879-015-1111-9
  3. doi:10.2139/ssrn.3563092

Currently, the most common source of iodine disinfection is PVP-1, but there are limitations of use due to its staining, toxicity, and taste. This new generation of iodine products is now available and has eliminated these negative effects by isolating, stabilizing, and concentrating the bioactive I2. This has enormous implications in the management and treatment of many microbial-sourced diseases. Since I2 has been proven to completely inactivate the COVID-19 virus, it seems prudent that it be used in medical and dental environments.

Source:10.1016/j.mehy.2020.109860

Most doctors know the need to focus now on early treatment as the most immediate and practical way to reduce hospitalizations and death. However, some doctors and media channels argue that there is very little evidence to support the use of povidone-iodine to prevent or treat COVID-19.

Below, we look at the studies for Povidone-Iodine (PVP) and COVID-19:

8 Povidone Iodine against COVID-19 Studies

1. Rapid initiation of nasal saline irrigation: hospitalizations in COVID-19 patients randomized to alkalinization or povidone-iodine compared to a national dataset

Baxter et al., medRxiv, doi:10.1101/2021.08.16.21262044 (Preprint)

Small RCT 79 PCR+ patients 55+ comparing pressure-based nasal irrigation with povidone-iodine and sodium bicarbonate, showing improved recovery with povidone-iodine, and 0/37 COVID-19 related hospitalizations for povidone-iodine compared to 1/42 for sodium bicarbonate. NCT04559035. 

2. Virucidal effect of povidone iodine on COVID-19 in the nasopharynx: an open-label randomized clinical trial

Arefin et al., Indian Journal of Otolaryngology and Head & Neck Surgery, doi:10.1007/s12070-021-02616-7 (Peer Reviewed)

RCT with 189 patients showing significantly greater viral clearance with a single application of PVP-I. Authors recommend using PVP-I prophylactically in the nasopharynx and oropharynx. NCT04549376

3. Positive impact of oral hydroxychloroquine and povidone-iodine throat spray for COVID-19 prophylaxis: an open-label randomized trial 

Prophylaxis RCT in Singapore with 3,037 low risk patients, showing lower serious cases, lower symptomatic cases, and lower confirmed cases of COVID-19 with all treatments (ivermectin, HCQ, PVP-I, and Zinc + vitamin C) compared to vitamin C.Meta-analysis of vitamin C in 6 previous trials shows a benefit of 16%, so the actual benefit of ivermectin, HCQ, and PVP-I may be higher. Cluster RCT with 40 clusters.There were no hospitalizations and no deaths. NCT04446104.

4. In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial

Small RCT comparing mouthwashing with PVP-I, Chlorhexidine, and water, showing significant efficacy for both PVP-I and Chlorhexidine, with PVP-I increasing Ct by a mean of 4.45 (p < 0.0001) and Chlorhexidine by a mean of 5.69 (p < 0.0001), compared to no significant difference for water.

 

Elzein et al., Journal of Evidence Based Dental Practice, doi:10.1016/j.jebdp.2021.101584 (preprint 3/17) (Peer Reviewed), Double Blind Randomized Controlled Trial, Lebanon, Middle East, 7 authors.
 

5. Can povidone Iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence-based update 

Review discussing the rationale, safety, recommendations, and dosage of PVP-I gargle/mouthwash as an effective method to decrease the viral load of SARS-CoV-2. 
 
 
Chopra et al., 3/15/2021, peer-reviewed, 5 authors.
 

6. Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19: A Randomized Clinical Trial 

RCT of PCR+ patients with Ct<=20 with 12 treatment and 12 control patients, concluding that nasopharyngeal decolonization may reduce the carriage of infectious SARS-CoV-2 in adults with mild to moderate COVID-19. All patients but 1 had negative viral titer by day 3 (group not specified). There was no significant difference in viral RNA quantification over time. The mean relative difference in viral titers between baseline and day 1 was 75% [43%-95%] in the intervention group and 32% [10%-65%] in the control group. Thyroid dysfunction occurred in 42% of treated patients, with spontaneous resolution after the end of treatment. Patients in the treatment group were younger.

relative improvement in viral titer reduction between baseline and day 1, 63.2% lower, RR 0.37, p = 0.25, treatment 12, control 12.
Guenezan et al., 2/4/2021, Randomized Controlled Trial, France, Europe, peer-reviewed, 7 authors.
 

7. Effect of 1% Povidone Iodine Mouthwash/Gargle, Nasal and Eye Drop in COVID-19 patients

RCT 606 patients in Bangladesh for povidone iodine mouthwash/gargle, nasal drops and eye drops showing significantly lower death, hospitalization, and PCR+ at day 7.

risk of death, 88.2% lower, RR 0.12, p < 0.001, treatment 2 of 303 (0.7%), control 17 of 303 (5.6%).
risk of hospitalization, 84.4% lower, RR 0.16, p < 0.001, treatment 12 of 303 (4.0%), control 77 of 303 (25.4%).
risk of no virological cure, 96.2% lower, RR 0.04, p < 0.001, treatment 8 of 303 (2.6%), control 213 of 303 (70.3%), day 7.
Choudhury et al., 12/3/2020, Randomized Controlled Trial, Bangladesh, South Asia, peer-reviewed, 6 authors.
 

8. Early viral clearance among COVID-19 patients when gargling with povidone-iodine and essential oils: a pilot clinical trial

Early viral clearance among COVID-19 patients when gargling with povidone-iodine and essential oils: a pilot clinical trial Tiny RCT with 5 PVP-I patients, gargling 30 seconds, 3x per day, and 5 control patients (essential oils and tap water were also tested), showing improved viral clearance with PVP-I.


Mohamed et al., medRxiv, doi:10.1101/2020.09.07.20180448 (Preprint), 9/9/2020, Randomized Controlled Trial, Malaysia, Europe, 16 authors.
 
 
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