Table 3.
Antiviral effect against SARS-CoV-2 in in vitro and clinical studies.
| Mouthwash | Study type | N° of studies | Concentration | Dosage | Antiviral effect against SARS-CoV-2 | Overall effect |
|---|---|---|---|---|---|---|
| H2O2 | Clinical study | 2 (Chaudhary et al., 2021, Gottsauner et al., 2020) (High risk) | H2O2 1% | 20 mL for 30 sec / 15 mL for 1 min | Varied effect | Varied effect |
| 1 (Eduardo et al., 2021) (Unclear risk) | H2O2 1.5% | 10 mL for 1 min |
Effective | |||
| In vitro study | 5 (Bidra et al., 2020a, Davies et al., 2021, Koch-Heier et al., 2021, Meister et al., 2020, Xu et al., 2021) | H2O2 1.5%, | 15 sec, 30 sec | Low effect to no effect | Low to no effect in vitro | |
| 1 (Bidra et al., 2020a) | H2O2 3.0% | 15 sec to 30 sec | Low effect | |||
| CHX | Clinical study | 2(Chaudhary et al., 2021, Eduardo et al., 2021) (Unclear and high risk) | CHX 0.12% | 15 mL for 30 sec | Effective | Varied effect, to effective in patients |
| 3 (Avhad et al., 2020, Elzein et al., 2021, Seneviratne et al., 2021) (unclear risk) | CHX 0.2% | 15 mL for 30 sec |
Varied effect, to effective | |||
| In vitro study | 2 (Koch-Heier et al., 2021, Steinhauer et al., 2021) | CHX 0.1% | 30 sec | No effect | Variable to no effect in vitro | |
| 3 (Jain et al., 2021, Komine et al., 2021, Xu et al., 2021) | CHX 0.12% | 30 sec to 60 sec | Variable effect | |||
| 4 (Davies et al., 2021, Jain et al., 2021, Meister et al., 2020, Steinhauer et al., 2021) | CHX 0.2% | 30 sec to 60 sec | Variable effect | |||
| 2 (Davies et al., 2021, Statkute et al., 2020) | CHX 0.2% + Ethanol | 30 sec to 60 sec | Low to no effect | |||
| H2O2 + CHX | Clinical study | 1 (Eduardo et al., 2021) (Unclear risk) | H2O21.5% + CHX 0.12% |
10 mL of H2O2 for 1 min, followed by 15 mL of CHX for 30 sec |
Minimal effect | Minimal effect |
| PVP-I | Clinical study | 2 (Chaudhary et al., 2021, Seneviratne et al., 2021) (Unclear and high risk) | PVP-I 0.5% | 5 mL for 30 sec / 15 mL for 1 min |
Effective | Varied effect, mostly effective in patients |
| 4 (Choudhury et al., 2020, Elzein et al., 2021, Guenezan et al., 2021, Mohamed et al., 2020) (Unclear and high risk) | PVP-I 1% |
10–15 mL for 30 sec, 3–4 times a day | Varied effect, mostly effective | |||
| In vitro study | 7 (Anderson et al., 2020, Bidra et al., 2020a, Bidra et al., 2020b, Davies et al., 2021, Hassandarvish et al., 2020, Pelletier et al., 2021, Statkute et al., 2020) | PVP-I 0.5% | 15 sec to 60 sec | Moderate to high effect | Moderate to high effect in vitro | |
| 2(Bidra et al., 2020b, Pelletier et al., 2021) | PVP-I 0.75% | 15 sec to 60 sec | High effect | |||
| 5(Anderson et al., 2020, Hassandarvish et al., 2020, Jain et al., 2021, Meister et al., 2020, Xu et al., 2021) | PVP-I 1.0% | 15 sec to 60 sec | Mostly high effect | |||
| 1 (Bidra et al., 2020a) | PVP-I 1.25% | 15 sec to 30 sec | High effect | |||
| 3 (Bidra et al., 2020a, Bidra et al., 2020b, Pelletier et al., 2021) | PVP-I 1.5% | 15 sec to 60 sec | High effect | |||
| Essential oils | Clinical study | 1 (Mohamed et al., 2020) (High risk) | Ethanol + essential oils (Eucalyptol, Menthol, Methyl salicylate, Thymol) | 20 mL for 30 sec, 3 times a day | Effective | Effective in patients |
| In vitro study | 4 (Davies et al., 2021, Meister et al., 2020, Statkute et al., 2020, Xu et al., 2021) | Ethanol + essential oils (Eucalyptol, Menthol, Methyl salicylate, Thymol) | 30 sec to 60 sec | Moderate to high effect | Moderate to high effect in vitro | |
| CPC | Clinical study | 1 (Seneviratne et al., 2021) (Unclear risk) | CPC 0.075% | 20 mL for 30 sec |
Effective | Effective in patients |
| In vitro study |
1 (Komine et al., 2021) | CPC 0.04% mouthwash | 20 sec | High effect | Moderate to high effect in vitro | |
| 1 (Komine et al., 2021) | CPC 0.05% (alcoholic type) | 20 sec to 30 sec | High effect | |||
| 4 (Koch-Heier et al., 2021, Komine et al., 2021, Muñoz-Basagoiti et al., 2021, Statkute et al., 2020) | CPC 0.05% (non-alcoholic type) | 20 sec-2 min | High effect | |||
| 2 (Komine et al., 2021, Muñoz-Basagoiti et al., 2021) | CPC 0.075% | 30 sec to 1 min | High effect | |||
| 1 (Statkute et al., 2020) | CPC 0.07–0.1% + sodium citric acid 0.05% | 30 sec | Moderate effect | |||
| CPC + Zinc | Clinical study | 1 (Eduardo et al., 2021) (Unclear risk) | CPC 0.075% + Zinc lactate 0.28% | 20 mL for 30 sec |
Effective | Effective in patients |
| CPC + H2O2 | In vitro study | 1 (Koch-Heier et al., 2021) | CPC 0.05%, H2O2 1.5% |
30 sec | High effect | High effect in vitro |
| CHX + CPC | In vitro study | 1 (Komine et al., 2021) | CHX 0.06% + CPC 0.05% | 30 sec | High effect | High effect in vitro |
| 1 (Koch-Heier et al., 2021) | CHX 0.1% + CPC 0.05% | 30sec | High effect | |||
| 2 (Komine et al., 2021, Muñoz-Basagoiti et al., 2021) | CHX 0.12% + CPC 0.05% | 30 sec to 2 min | High effect | |||
| Octenidine dihydrochloride | In vitro study | 2 (Meister et al., 2020, Steinhauer et al., 2021) | Octenidine dihydrochloride 0.1%, phenoxyethanol 2% | 15 sec, 30 sec, 1 min | Moderate to high effect | Moderate to high effect in vitro |
| APD | In vitro study | 2 (C. A. Santos et al., 2021; P. S. da S. Santos et al., 2021) | APD | 30 sec, 1 min, 5 min, 30 min | High effect | High effect in vitro |
| Chlorine dioxide | Clinical study | 1 (Avhad et al., 2020) (Unclear risk) | Chlorine dioxide 0.1% | 10 mL 3 times a day |
More effective than CHX | Variable effect in patients |
| Dequalinium chloride | In vitro study | 1 (Meister et al., 2020) | Dequalinium chloride 1.5 mg, benzalkonium chloride 3.5 mg | 30 sec | High effect | High effect in vitro |
| Polyaminopropyl biguanide | In vitro study | 1 (Meister et al., 2020) | Polyaminopropyl biguanide (polyhexanide) 0,1 - < 0,25% | 30 sec | Moderate to high effect | Moderate to high effect in vitro |
| Ethanol + ethyl lauroyl arginate | In vitro study | 1 (Statkute et al., 2020) | Ethanol 23%, ethyl lauroyl arginate 0.147% | 30 sec | High effect | High effect in vitro |
| Delmopinol | In vitro study | 1 (Komine et al., 2021) | Delmopinol 0.20% mouthwash | 30 sec | High effect | High effect in vitro |
| Dipotassium oxalate | In vitro study | 1 (Davies et al., 2021) | Dipotassium oxalate 1.4% | 1 min | High effect | High effect in vitro |
| Stabilized hypochlorous acid | In vitro study | 1 (Davies et al., 2021) | Stabilized hypochlorous acid 0.01–0.02% | 1 min | Variable effect | Variable effect in vitro |
| CDCM (β-cyclodextrin-citrox) | Clinical study | 1 (Florence Carrouel et al., 2021a) (Low risk) | CDCM (β-cyclodextrin-citrox) |
30 mL for 1 min, 3 times a day | Effective | Effective in patients |
| Sorbitol and xylitol | Clinical study | 1 (Schürmann et al., 2021) (High risk) | Sorbitol and xylitol | 1 min | Effective | Effective in patients |
1 H2O2: Hydrogen peroxide; CHX: Chlorhexidine digluconate; PVP-I: Povidone-iodine; CPC: Cetylpyridinium chloride; APD: Anionic phtalocyanine derivate.