Povidone-Iodine for SARS-CoV-2 Nasopharyngeal Decontamination: Updated Evidence (2020–2026)
Abstract Background: Povidone-iodine (PVP-I) has been proposed as a topical antiviral intervention targeting SARS-CoV-2 replication in the nasopharynx. While early pandemic recommendations were largely mechanistic, recent studies (2024–2025) provide more structured clinical evidence. Objective: To evaluate updated clinical efficacy, safety, and translational relevance of PVP-I nasal and oral applications in COVID-19. Methods: Narrative review of in vitro studies, randomized controlled trials (RCTs), and systematic reviews published between 2020 and 2025. Results: Recent meta-analysis (2025) suggests PVP-I reduces viral load compared with controls, though effects are modest and not always statistically significant. Randomized trials (2024) confirm shortened viral clearance time but no clear reduction in severe outcomes. Evidence from a 2025 phase III trial in upper respiratory infections supports antiviral activity in real-world viral illnesses. ...