Virucidal efficacy of chlorhexidine: a systematic review

Matheus Dos Santos Fernandez, Maria Izabel Florindo Guedes, Gerson Pedro José Langa, Cassiano Kuchenbecker Rösing, Juliano Cavagni, Francisco Wilker Mustafa Gomes Muniz, Matheus Dos Santos Fernandez, Maria Izabel Florindo Guedes, Gerson Pedro José Langa, Cassiano Kuchenbecker Rösing, Juliano Cavagni, Francisco Wilker Mustafa Gomes Muniz

Abstract

This study aimed to systematically review the literature about the virucidal efficacy of CHX in comparison to other substances used in the oral cavity. Electronic searches were performed in four databases (PubMed, Scopus, Embase, and Web of Science). Only studies that presented the following characteristics were included: (1) verified virucidal efficacy of CHX against Herpes Simplex Type-1 (HSV-1), any Influenza, or any human coronavirus (HcoV); and (2) compared the virucidal efficacy of CHX with essential oils (Listerine®), quaternary ammonium compounds, povidone-iodine, hydrogen peroxide, negative control substance, and absence of therapy. Two researchers independently selected the studies, extracted data and evaluated the risk of bias. A narrative data synthesis was used. Twenty-five studies were included, of which 21 were in vitro and four were randomized clinical trials (RCT). Studies assessed the virucidal efficacy of CHX against Herpes Simplex Type-1 (HSV-1) (10 studies), Influenza A (InfluA) (4 studies), human coronavirus (HCoV) (4 studies) and Severe Acute Respiratory Syndrome-Related Coronavirus (SARS-CoV-2) (11 studies). Most studies demonstrated that CHX has a positive virucidal efficacy against HSV-1 and InfluA strains. However, lower efficacy was shown to InfluA strain in comparison to povidone-iodine. Lower to none virucidal efficacy of CHX is expected for HCoV and SARS-CoV-2 strains for in vitro studies. Three RCT demonstrated that CHX was able to significantly reduce the viral load of SARS-CoV-2 for a short period. CHX may present an interesting virucidal efficacy against HSV-1 and InfluA viruses. CHX also presents transient efficacy against SARS-CoV-2 when used as a mouthwash.

Keywords: Antiseptics; Chlorhexidine; Mouthrinses; Mouthwashes; Virus.

Conflict of interest statement

The authors report no conflict of interest related to this study.

© 2021. The Society of The Nippon Dental University.

Figures

Fig. 1
Fig. 1
Flow chart of studies selection according to PRISMA statement
Fig. 2
Fig. 2
Risk of bias of the in vitro included studies
Fig. 3
Fig. 3
Risk of bias assessment of included the randomized controlled trials

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