Efficacy of three antimicrobial mouthwashes in reducing SARS-CoV-2 viral load in the saliva of hospitalized patients: a randomized controlled pilot study

Jeniffer Perussolo, Muy-Teck Teh, Nikolaos Gkranias, Simon Tiberi, Aviva Petrie, Maria-Teresa Cutino-Moguel, Nikolaos Donos, Jeniffer Perussolo, Muy-Teck Teh, Nikolaos Gkranias, Simon Tiberi, Aviva Petrie, Maria-Teresa Cutino-Moguel, Nikolaos Donos

Abstract

This study aimed to evaluate the efficacy of 3 mouthwashes in reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in the saliva of coronavirus disease 2019 (COVID-19) patients at 30 min, 1, 2 and 3 h after rinsing. This pilot study included 40 admitted COVID-19 positive patients (10 in each group). Saliva samples were collected before rinsing and at 30 min, 1, 2 and 3 h after rinsing with: Group 1-0.2% Chlorhexidine digluconate (CHX); Group 2-1.5% Hydrogen peroxide (H2O2); Group 3-Cetylpyridinium chloride (CPC) or Group 4 (control group)-No rinsing. Viral load analysis of saliva samples was assessed by Reverse Transcription quantitative PCR. Mean log10 viral load at different time points was compared to that at baseline in all groups using a random effects linear regression analysis while for comparison between groups linear regression analysis was used. The results showed that all groups had a significantly reduced mean log10 viral load both at 2 (p = 0.036) and 3 (p = 0.041) hours compared to baseline. However, there was no difference in mean log10 viral load between any of the investigated mouthwashes and the control group (non-rinsing) at the evaluated time points. Although a reduction in the SARS-CoV-2 viral load in the saliva of COVID-19 patients was observed after rinsing with mouthwashes containing 0.2% CHX, 1.5% H2O2, or CPC, the reduction detected was similar to that achieved by the control group at the investigated time points. The findings of this study may suggest that the mechanical action of rinsing/spitting results in reduction of SARS-CoV-2 salivary load.

Conflict of interest statement

N.D. had an advisory role at GlaxoSmithKline (GSK) and was awarded a GSK Consumer Healthcare (GSKCH) research grant, which provided funding for this study. ND has also lectured for Oral-B. S.T. is a GSK Global Health Consultant. J.P., N.G., A.P., M.T. and M.C.M. do not report any competing interest.

© 2023. Springer Nature Limited.

Figures

Figure 1
Figure 1
Flowchart with trial profile.
Figure 2
Figure 2
One-step RT-qPCR workflow for quantification of salivary SARS-CoV-2 viral load using MagMAX Viral/Pathogen Nucleic Acid Isolation Kit, genesig COVID-19 qPCR Assay. Figure created using CorelDRAW Graphics Suite 2017 (version 19.1.0.419) https://www.coreldraw.com/en/pages/coreldraw-2017/.
Figure 3
Figure 3
Box plot presenting mean (cross within the box), median (horizontal line within the box), interquartile range, minimum and maximum log10 viral load for each group at baseline.
Figure 4
Figure 4
Log10 viral load for individual patients in the Groups 1 to 4 at different time points. Graphs created with Stata (StataCorp. 2021. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC.) Available at https://www.stata.com/products/.
Figure 5
Figure 5
Mean log10 viral load for each group with 95% confidence interval (CI) linked at the different time points. Graph created with Stata (StataCorp. 2021. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC.). Available at https://www.stata.com/products/.

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