Antiseptics as effective virucidal agents against SARS-CoV-2: Systematic review and Bayesian network meta-analysis

This study represents the first Bayesian network meta-analysis (NMA), which aimed to determine the virucidal efficacy of oral and nasal antiseptics against SARS-CoV-2 in saliva. Eligible studies evaluated the antiseptics' effect on viral load in SARS-CoV-2-infected subjects. The search was performed in September 2024 through PubMed, World Health Organisation, Embase, Scopus, bioRxiv, and medRxiv. The methodological quality was evaluated using the Cochrane RoB-2 checklist. Twenty-six articles and 16 antiseptics were assessed. Bayesian NMA was possible for seven antiseptics, ranked by probability of best option for viral load reduction (SUCRA values): PVP-I (0.85); CPC and CHX (0.72); H₂O₂ (0.70); CHX (0.64); CPC (0.50); H₂O₂ and CHX (0.38); and HClO (0.34). Virucidal efficacy at baseline was significant for (viral load reduction): PVP-I (42 %), H₂O₂ (34 %), and CHX (31 %). Compared to the control group, PVP-I remained significant (34 %), whereas H₂O₂ and CHX approached significance (26 % and 22 %, respectively). In conclusion, a single application of PVP-I, H₂O₂ or CHX are the best options for reducing the SARS-CoV-2 viral load in saliva, which can be particularly relevant in high-risk settings. However, methodologically well-designed studies using more appropriate quantification techniques are needed to clarify better the clinical efficacy of antiseptics against SARS-CoV-2 and other respiratory viruses.