Jurnal dari Huang YH, Huang JT.
Use of chlorhexidine to eradicate oropharyngeal SARS-CoV-2 in COVID-19 patients. J Med Virol. 2021;93:4370-4373. https://doi.org/10.1002/jmv.26954
Abstract
As the distribution of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is ongoing, the prevention of coronavirus disease 2019 (COVID-19) relies on minimizing spread. In this study, Chlorhexidine gluconate was investigated as a topical antimicrobial agent against SARS-CoV-2. This was a randomized prospective cohort study using Chlorhexidine as a mouthwash and posterior oropharyngeal spray in hospitalized COVID-19 patients. The primary outcome was the presence or absence of laboratory-confirmed SARS-CoV-2 in the oral cavity and oropharynx after 4 days of using Chlorhexidine and standard of care (study group) or standard of care alone (control group). SARS-Co-!2 was eliminated from the oropharynx in 62.1% of patients who used Chlorhexidine as a mouthwash, compared to 5.5% of control group patients. Among patients who used a combination of oral rinse and oropharyngeal spray, 86.0% eliminated oropharyngeal SARS-CoV-2, compared to 6.3% of control patients. Chlorhexidine is a simple and safe addition to current COVID-19 prevention guidelines and could play an important role in reducing the spread of the disease.
Materials and Methods
This is a prospective cohort study conducted at four community hospitals in Los Angeles, CA (East Los Angeles Physicians Hospital, Huntington Park Community Hospital, Alhambra Hospital Medical Center, and Garfield Medical Center). The study was conducted in accordance with the Declaration of Helsinki guidelines and approved by the Ethics Committees of the Pipeline Health and AHMC Healthcare hospital systems. Written informed consent was obtained from all subjects involved in the study. COVID-19 patients who kept their distance, wore masks, and washed their hands to prevent transmission of COVID-19. Healthcare workers were followed throughout the study period, and adherence to the Chlorhexidine regimen and COVID-19 status were self-reported. The SARS-CoV-2 infection rate among this group was compared with the infection rate among all healthcare workers in their respective hospitals.
Results
684 patients with positive SARS-CoV-2 infection were identified. The average onset of symptoms was 5-6 days prior to hospital admission. 390 patients were excluded due to symptom onset more than 6 days prior to admission, nasogastric or endotracheal tube insertion, or inability to follow Chlorhexidine use instructions. 58% of the study population were male, 42% female, and the mean age was 62 years (range, 23-89). 294 patients were included in the analysis, with 159 patients in the study group receiving Chlorhexidine and 135 patients in the control group. All patients received standard of care for COVID-19, including remdesivir, anticoagulants, steroids, and oxygen therapy. There was no significant difference in response to treatment between the two groups.
Discussion
Chlorhexidine is an antimicrobial agent commonly used in preoperative skin preparation to prevent postoperative infections, dental plaque prevention, and prevention of ventilator-associated pneumonia. Due to its cationic nature, Chlorhexidine has been shown to be effective in killing enveloped viruses. As SARS-CoV-2 is an enveloped virus, Chlorhexidine has been shown to be effective against SARS-CoV-2.
Data from this study showed significant elimination of SARS-CoV-2 with Chlorhexidine application in the oral cavity and pharynx. In an effort to deliver Chlorhexidine to the posterior oropharynx more effectively, a spray applicator was used to apply Chlorhexidine to the posterior oropharynx directly. In this study population, the addition of posterior oropharyngeal Chlorhexidine spray was associated with elimination of SARS-CoV-2 from the oropharynx in 86.0% of patients, compared to 62.1% in patients who used Chlorhexidine as mouthwash alone. These results suggest that applying Chlorhexidine to the posterior oropharynx greatly enhances the clearance of SARS-CoV-2 from the oropharynx.
Chlorhexidine was noted to be highly effective in preventing SARS-CoV-2 infection in a small group of healthcare workers when compared to the general hospital healthcare worker population in this study. This observation is encouraging, but formal analysis was not performed on this group. Further research with a larger cohort is needed to investigate the use of Chlorhexidine in preventing COVID-19 in healthcare workers.
The authors propose that the use of Chlorhexidine as an oropharyngeal rinse may serve two purposes:
(1) to prevent the spread of the virus from COVID-19 patients to others and
(2) to prevent SARS-CoV-2 infection in the event of exposure to the virus. To prevent the spread of the virus from a SARS-CoV-2 infected person to others, the authors recommend using Chlorhexidine gluconate 0.12% mouthwash twice a day as follows:
(1) spray 1 ml into the nose,
(2) rinse the throat thoroughly with 15 ml for at least 30 seconds, and
(3) use the spray applicator to spray the back of the throat three times (1.5 ml).
This process can be continued until the virus is naturally cleared from the body, which takes approximately 2-3 weeks.11 For post-exposure prophylaxis, the authors recommend the above Chlorhexidine regimen for 2-4 days. The authors must emphasize that Chlorhexidine cannot be used to treat COVID-19, and strongly discourage the use of Chlorhexidine in any attempt to eradicate the disease.
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