The Effect of <scp>Povidone‐Iodine</scp> Nasal Spray on Nasopharyngeal SARS‐CoV‐2 Viral Load: A Randomized Control Trial

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  • David Zarabanda
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.
  • Neelaysh Vukkadala
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.
  • Katie M. Phillips
    Department of Otolaryngology‐Head and Neck Surgery University of Cincinnati School of Medicine Cincinnati Ohio U.S.A.
  • Z. Jason Qian
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.
  • Kenji O. Mfuh
    Clinical Virology Laboratory Stanford Health Care Stanford California U.S.A.
  • Matthew J. Hatter
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.
  • Ivan T. Lee
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.
  • Vidya K. Rao
    Divisions of Cardiothoracic Anesthesiology and Critical Medicine, Department of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine Stanford California U.S.A.
  • Peter H. Hwang
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.
  • George Domb
    Shasta‐ENT Medical Group Redding California U.S.A.
  • Zara M. Patel
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.
  • Benjamin A. Pinsky
    Clinical Virology Laboratory Stanford Health Care Stanford California U.S.A.
  • Jayakar V. Nayak
    Department of Otolaryngology‐Head and Neck Surgery Stanford University School of Medicine Stanford California U.S.A.

抄録

<jats:sec><jats:title>Objectives/Hypothesis</jats:title><jats:p>To determine the effect of povidone‐iodine (PVP‐I) nasal sprays on nasopharyngeal (NP) viral load as assessed by cycle threshold (Ct) on quantitative polymerase chain reaction (qPCR) of SARS‐CoV‐2 in outpatients.</jats:p></jats:sec><jats:sec><jats:title>Study Design</jats:title><jats:p>Three arm, triple blinded, randomized, placebo‐controlled clinical trial.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Participants were randomized within 5 days of testing positive for COVID‐19 to receive nasal sprays containing placebo (0.9% saline), 0.5% PVP‐I, or 2.0% PVP‐I. NP swabs for qPCR analysis were taken at baseline, 1‐hour post‐PVP‐I spray (two sprays/nostril), and 3 days post‐PVP‐I spray (20 sprays/nostril). Symptom and adverse event questionnaires were completed at baseline, day 3, and day 5. University of Pennsylvania Smell Identification Tests (UPSIT) were completed at baseline and day 30.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean Ct values increased over time in all groups, indicating declining viral loads, with no statistically significant difference noted in the rate of change between placebo and PVP‐I groups. The 2.0% PVP‐I group showed statistically significant improvement in all symptom categories; however, it also reported a high rate of nasal burning. Olfaction via UPSIT showed improvement by at least one category in all groups. There were no hospitalizations or mortalities within 30 days of study enrollment.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Saline and low concentration PVP‐I nasal sprays are well tolerated. Similar reductions in SARS‐CoV‐2 NP viral load were seen over time in all groups. All treatment groups showed improvement in olfaction over 30 days. These data suggest that dilute versions of PVP‐I nasal spray are safe for topical use in the nasal cavity, but that PVP‐I does not demonstrate virucidal activity in COVID‐19 positive outpatients.</jats:p></jats:sec><jats:sec><jats:title>Level of Evidence</jats:title><jats:p>2 <jats:italic>Laryngoscope</jats:italic>, 132:2089–2095, 2022</jats:p></jats:sec>

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