Abstract
A review of nasal sprays and gargles with antiviral properties suggests that a number of commonly used antiseptics including povidone-iodine, Listerine®, iota-carrageenan and chlorhexidine should be studied in clinical trials to mitigate both the progression and transmission of SARS-CoV-2. Several of these antiseptics have demonstrated the ability to cut the viral load of SARS-CoV-2 by 3–4 log10 in 15–30 s in vitro. In addition, hypertonic saline targets viral replication by increasing hypochlorous acid inside the cell. A number of clinical trials are in process to study these interventions both for prevention of transmission, prophylaxis after exposure, and to diminish progression by reduction of viral load in the early stages of infection.
Highlights
While nasal sprays and gargles cannot replace the use of traditional personal protective equipment, the use of nasal and oral antisepsis has the potential to be useful for combating SARS-CoV-2
Clinical trials currently underway will be the best mechanism to determine the true benefit of these compounds and their role in mitigating disease progress and transmission of SARS-CoV-2 infection
The results of ongoing and future clinical trials will determine the role of these agents for SARS-CoV-2 mitigation
Summary
A preliminary search for this review was conducted in PubMed using the search terms ‘nasal antisepsis’ and ‘throat antisepsis’ paired independently with ‘antiviral’ and ‘virus’. Based on the preliminary search, a new search was conducted in PubMed using the following search terms: (SARS-CoV-2 OR Covid-19 OR coronavirus OR SARS-CoV OR middle east respiratory syndrome coronavirus (MERS-CoV) OR SARS OR MERS) AND (nasal OR throat OR oral) AND (antimicrobial OR mouthwash OR rinse OR gargle OR antisepsis OR antiviral OR virucide OR biocide OR antiseptic prophylaxis) AND (catechin OR cyclodextrin OR citrox OR quaternary ammonium compounds OR cetrimide OR octenidine dihydrochloride OR dequonal OR benzalkonium chloride OR dequalinium chloride OR sage extract OR sodium hypochlorite OR PVP OR Nozin OR chlorhexidine OR cetylpyridinium chloride OR ethanol OR hydrogen peroxide OR hypertonic saline OR carrageenan) This search resulted in 47 individual results. The only class of compounds that were commercially available but were excluded were the quaternary ammonium compounds due to safety concerns identified during the preliminary search
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