corona virus infection, portal of entry , use of PVP-1 as prophylaxis and reducing infectivity

1. Role Of Povidone-Iodine
Gargle & Nasal Application in Covid-19
Dr. Sumita Shankar M.Ch (Plastic Surgery)
FICS (USA, Barcelona) Carl Zeiss Fellow in Hand & Microsurgery
Asso. Prof. & HOD Plastic Surgery
RMC Kakinada, AP. INDIA
Managing Director AMAZE MEDSPA
Laser & Cosmetic Surgery Centre

2. Disclaimer:
⬥This webinar is an initiative by Mundi Pharma
(Bangladesh) for academic interest
⬥There are no financial Implications involved

3. ‘Seeking Simple Solutions to
Complex Issues’
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4. 5

5. “Those who fail to learn from
history are doomed to repeat it.”
Sir Winston Churchill.
Sometimes it is essential to look back in order to move
forward
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7. Evolution
⬥Significant contribution to the overall
antimicrobial activity:
Free or molecular iodine (I2
) &
Hypoiodous acid
⬥ Active component I2 since 3000 BC
⬥Found naturally in seaweed and sea
sponges
⬥Synthesized by reaction of potassium iodide
with copper sulfate

8. Iodine Compounds
⬥ Tinctures of iodine (e.g., 2% iodine and 2.4% potassium
iodide in ethanol)
⬥ Lugol’s solution (5% iodine and 10% potassium iodide in
water).
⬥ Iodophors Elemental iodine complexed or bound with
high-molecular- weight neutral polymers, alcohol, amide,
and sugar polymers.

9. Iodophors & other Compounds
⬥PVP-I solutions Prepared in an aqueous (water)
or organic (e.g., alcohol) base (1955)
⬥Cadexomer
Iodine Dextrin with epichlorhydrin coupled with
ion-exchange groups and iodine. Polymer with
0.9% iodine (w/w), within a helical matrix (1980)
⬥CupriDyne aqueous elemental iodine (I2) and
cuprous iodide (CuI) in equilibrium (2020)
⬥Io-rinse Florida-based company, developed and
patented stable aqueous formulations of I2 (2020)

11. Poly(N-vinyl-2-pyrrolidone Iodine (PVP-I)
⬥Commercial use in 1955
⬥It is on the WHO's List of Essential Medicines, the
safest and most effective medicines needed in a
health system
⬥Is available over the counter
⬥These complexes have the benefits of increasing
the solubility and stability of iodine by allowing the
active iodine species to be slowly released over
time

12. ⬥PVP-I maintains an equilibrium in a triiodide
forms(e.g., I2, I-, I3-, PVP-I3-)in solutions, with the
total amount of all these forms measured as
available iodine content in sodium thiosulfate
titration.
⬥Free iodine(I2), which is released contribute to the
biocidal activity of PVP-I
Poly(N-vinyl-2-pyrrolidone Iodine (PVP-I)

13. PVP-I Free iodine concentration
(ppm)
⬥ 0.01% 1.84
⬥ 0.1% 4.88
(available iodine: 0.01%)
⬥ 1% 1.58
⬥ 10% 0.17
(available iodine: 1% )
at 25°C(the PVP-I) PB ranked in the descending order of
0.1% > 0.01% ≥ 1%
⬥ The inactivation is dependent on the concentration of free iodine.
⬥ It decreases with the increasing concentration of PVP‐I especially within the
range of 5%–10% (Atemnkeng, Plaizier‐Vercammen, & Schuermans, 2006).

15. Comparative Biocide Resistance

16. Spectrum of Activity
⬥PVP-I is a microbicide that exerts broad‐spectrum
activity against bacteria, fungi, protozoa, and viruses
⬥ Virucidal agent: As per the latest in vitro study from
Malaysia it is more than 99.9 % efficacious against
SARS-COV2
⬥An increasing number of studies in the literature are
testing the spectrum of virucidal efficacy from limited
virucidal activity to a high‐level of virucidal activity

17. Mechanism of action
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18. CoVs belong to
family of Coronaviridae
Subfamily Coronavirinae in
of the order Nidovirales,
this subfamily includes four
genera:
Alphacoronavirus,
Betacoronavirus,
Gammacoronavirus,
Deltacoronavirus

19. SARS COV-2
⬥ Coronaviruses are positive-
stranded RNA viruses with an
envelope containing glycoprotein
spikes
⬥ Viruses having an
envelope(outer lipid
membrane)are highly susceptible
to antiseptics

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23. Mechanism of action
⬥ Two specific mechanisms of reduction of viral growth,
namely, PVP-I blockade of viral attachment to the host cell
receptors and the inhibition of viral release from infected cells
⬥ Inhibits viral haemagglutinin, resulting in the blockade of
attachment to host cell receptors.
⬥ Inhibition of essential viral enzymes Neuraminidase which
blocks viral release from the host cell, preventing further
spread of the virus to uninfected cells.
⬥ Reduce chance of Resistance by simultaneously targeting
both critical aspects of the viral machinery needed for
replication, reduces the likelihood of resistance emerging
through sudden mutation.

24. SARS-COV2
⬥ Imperial College London- published last week said nose and
eyes are likely to be entry points for novel coronavirus.
⬥ The novel coronavirus requires ACE2 and TMPRSS2 Sars-
CoV-2 anchors to ACE2 receptor & TMPRSS2 activates entry
of the virus into a body cell.
⬥ Nose has -goblet and ciliated cells-- they have a very high
density of the facilitating proteins, makes it susceptible for
SARS-COV2
⬥ The mouth is directly linked with the nose and lungs making it
another gateway for the entry of the novel coronavirus. The
enabling proteins are also found in the esophagus, ileum
(small intestine) and colon 27

25. PVP-I' virucidal efficacy against
coronaviruses at concentrations as low as
0.23%, rapid efficacy at 15 s, and residual
efficacy in combination with isopropyl
alcohol or ethanol make it an excellent
choice for disinfecting skin, oral cavities,
and fomite surfaces (Eggers et al., 2015b;
Kampf et al., 2020)
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26. Role in COVID-19
⬥ Prophylaxis: (Pre and Post exposure), Frontline and
Health Care workers, Sanitary workers, Police personnel
Preoperative, before intubation
Pre dental procedures, ENT Procedures, head & Neck
Malignancies, Facio maxillary trauma, Neurosurgical
procedures
⬥ Covid-19 positive: to reduce the progression of disease
and spread by reducing infectivity
⬥ Prevention of second wave collectively if we all play
safe

27. Role in COVID-19
⬥ PVP-I could be used for hand washing and disinfection of
skin, surfaces and the oral tract, and as a substitute or
replacement for alcohol-based products (Durani and
Leaper, 2008).
⬥ The combination of PVP-I with alcohol as a disinfectant
could reduce the amount of alcohol required and could
serve as a useful substitute or supplement to alcohol use.

28. Dose, Mode of administration
Formulations: 10%, 2%, 5%, 1% (w/v or w/w)
⬥ ORAL
Gargle (2% diluted to 1%) / Throat sprays / Powder
After intake of food and preferably to remain NPO
for 15-30 minutes
⬥ NASAL
Application ( Ear buds ) / Nasal sprays / 2cc syringes
⬥ Duration : 30 s each gargle or rinse contact time
⬥ Frequency: Twice / QID / pre and post exposure

29. ⬥ Swabs ⬥ Nasal Spray ⬥ Throat Spray

30. Advantages
⬥ Broad spectrum of kill
⬥ Rapid speed of kill
⬥ Lack of microbial resistance
⬥ Excellent safety and allergy profile Substantivity
⬥ Ease of use
⬥ Affordable to patients
⬥ No deleterious side effects
⬥ Indicated for chronic use
⬥ Help prevent superceded bacterial infections
⬥ Helps prevent recurrent sinus infection
⬥ Oral hygiene
⬥ Happy breath
⬥ Improvement of Dental hygiene

31. Disadvantages
⬥ Staining of teeth
⬥ Allergy to compound
⬥ Taste and odour
⬥ Thyroid disorders
⬥ Patient on lithium
⬥ Children
⬥ Pregnancy and Lactation

32. Message
‘An ounce of prevention is worth a
pound of cure’
Just an ounce /day…

33. Namaste