ORAL ANTISEPTICS AGAINST CORONAVIRUS: IN VITRO AND CLINICAL EVIDENCE

Mateos Moreno, María Victoria; Obrador, Alejandro Mira; Márquez, Verónica Ausina; Ferrer García, María D.

BACKGROUND: Angiotensin converting enzyme II (ACE2) is the cellular receptor for SARS-CoV-2, so ACE2-expressing cells can act as target cells and are susceptible to infection. ACE2 receptors are highly expressed in the oral cavity so this may be a potential high-risk route for SARS-CoV-2 infection. Furthermore, the virus can be detected in saliva, even before COVID-19 symptoms appear, with the consequent high risk of virus transmission in asymptomatic/pre-symptomatic patients. Reducing oral viral load could lead to a lower risk of transmission via salivary droplets or aerosols and therefore contribute to the control of the pandemic. AIM: To evaluate the available evidence testing the in vitro and in vivo effects of oral antiseptics to inactivate or eradicate coronaviruses. METHODS: The criteria used were those described in the PRISMA® Declaration for performing systematic reviews. An electronic search in MEDLINE (via PubMed) and in Web of Sciences, using the terms MeSH: “mouthwash” OR “oral rinse” OR “mouth rinse” OR “povidone iodine” OR “hydrogen peroxide” OR “cetylpyridinium chloride” AND “COVID-19” OR “SARS-CoV-2” OR “coronavirus” OR “SARS” OR “MERS”. FINDINGS: The initial search strategy identified 619 articles on two electronic databases. A total of 17 articles were included assessing the virucidal efficacy of oral antiseptics against coronaviruses. CONCLUSIONS: There is sufficient in vitro evidence to support the use of antiseptics to potentially reduce the viral load of SARS-CoV-2 and other coronaviruses. However, in vivo evidence for most oral antiseptics is limited. Randomized clinical trials with a control group are needed to demonstrate its clinical efficacy.