An antiviral mouthwash and COVID-19

Using a mouthwash containing β-cyclodextrin and citrox (bioflavonoids) (CDCM), available in pharmacies, helps reduce the SARS-CoV-2 viral load in saliva

Keywords: Citrox; COVID-19; Mouthwash; Saliva; SARS-CoV-2; Viralload; ß-cyclodextrin


The intention-to-treat analysis demonstrated that, over the course of one day, CDCM was significantly more effective than placebo 4 hours after the first dose (p=0.036), with a median percentage (log10 copies/mL) decrease T1-T2 of -12.58% [-29.55% – -0.16%].

The second dose maintained the low median value for the CDCM (3.08 log10 copies/mL [0 – 4.19]), compared to placebo (3.31 [1.18 – 4.75]).

At day 7, there was still a greater median percentage (log10 copies/mL) decrease in salivary viral load over time in the CDCM group (-58.62% [-100% – -34.36%]) compared to placebo group (-50.62% [-100% – -27.66%]). These results were confirmed by the per-protocol analysis.

Description of the Study:

  • Title: Use of an antiviral mouthwash as a barrier measure in the SARS-Cov-2 transmission in adults with asymptomatic to mild COVID-19: a multicenter, randomized, double-blind controlled trial
  • Principal Investigators: Florence Carrouel, Martine Valette, Emilie Gadea, Aurélie Esparcieux, Gabriela Illes, Marie Elodie Langlois, Hervé Perrier, Claude Dussart, Paul Tramini, Mélina Ribaud, Maude Bouscambert-Duchamp and Denis Bourgeois.
  • Centers of Implementation: Participants were enrolled at four French hospital centers, and monitoring occurred at home.
  • Study Population: SARS-CoV-2 PCR-positive patients aged 18-85 years with 36 asymptomatic to mild COVID-19 symptoms <8 days were recruited.
  • Study Type: A multicenter, randomized, double-blind controlled trial.
  • Methods: A total of 176 eligible 37 patients were randomly assigned (1:1) to CDCM or placebo. Three rinses daily were performed for 7 days. Saliva sampling was performed on day 1 at 9 a.m. (T1), 1 p.m. (T2) and 6 p.m. (T3). On the following 6 days, one sample was taken at 3 p.m. Quantitative RT-PCR 40 was used to detect SARS-CoV-2.

Objectives of the Study:

Principal Objective: To determine if commercially available mouthwash with ß-cyclodextrin and citrox (bioflavonoids) (CDCM) could decrease the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary viral load.

More about this Study:

SARS-CoV-2 may be transmitted via saliva, even in patients who do not cough or have other respiratory symptoms. SARS-CoV-2 is identified in 91.7% of saliva samples from COVID-19 patients, and the load can reach up to 1.2×108 copies/mL.

The use of mouthwashes is an “adjuvant” treatment part of the usual treatment or individual prophylaxis, especially in oral health. Considering mouthwashes as agents that can decrease the viral load of SARS-CoV-2 is an extremely attractive concept. However, there is no in vivo evidence to recommend mouthwashes to control SARS-CoV-2 viral load. Among antiviral molecules contained in mouthwashes, hydrogen peroxide, ß-cyclodextrin, flavonoids, essential oils, cetylpyridinium chloride or povidone-iodine could be of interest in the fight against SARS-CoV-2. The antiviral activity of CDCM in our trial is based on ß-cyclodextrin and citrox (flavonoids). These molecules have demonstrated antiviral activity against several viruses, but evidence for their action against SARS-CoV-2 was based only on in silico studies.

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