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      Positive impact of oral hydroxychloroquine and povidone-iodine throat spray for COVID-19 prophylaxis: an open-label randomized trial

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          Abstract

          Background

          We examined whether existing licensed pharmacotherapies could reduce the spread of coronavirus disease 2019 (COVID-19).

          Methods

          An open-label parallel randomized controlled trial was performed among healthy migrant workers quarantined in a large multi-storey dormitory in Singapore. Forty clusters (each defined as individual floors of the dormitory) were randomly assigned to receive a 42-day prophylaxis regimen of either oral hydroxychloroquine (400 mg once, followed by 200 mg/day), oral ivermectin (12 mg once), povidone-iodine throat spray (3 times/day, 270 µg/day), oral zinc (80 mg/day)/vitamin C (500 mg/day) combination, or oral vitamin C, 500 mg/day. The primary outcome was laboratory evidence of SARS-CoV-2 infection as shown by either: (1) a positive serologic test for SARS-CoV-2 antibody on day 42, or (2) a positive PCR test for SARS-CoV-2 at any time between baseline and day 42.

          Results

          A total of 3,037 asymptomatic participants (mean age, 33.0 years; all men) who were seronegative to SARS-CoV-2 at baseline were included in the primary analysis. Follow-up was nearly complete (99.6%). Compared with vitamin C, significant absolute risk reductions (%, 98.75% confidence interval) were observed for oral hydroxychloroquine (21%, 2–42%) and povidone-iodine throat spray (24%, 7–39%). No statistically significant differences were observed with oral zinc/vitamin C combination (23%, –5 to +41%) and ivermectin (5%, –10 to +22%). Interruptions due to side effects were highest among participants who received zinc/vitamin C combination (6.9%), followed by vitamin C (4.7%), povidone-iodine (2.0%) and hydroxychloroquine (0.7%).

          Conclusions

          Chemoprophylaxis with either oral hydroxychloroquine or povidone-iodine throat spray was superior to oral vitamin C in reducing SARS-CoV-2 infection in young and healthy men.

          ClinicalTrials.gov number

          NCT04446104

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          Author and article information

          Journal
          Int J Infect Dis
          Int J Infect Dis
          International Journal of Infectious Diseases
          The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
          1201-9712
          1878-3511
          20 April 2021
          20 April 2021
          Affiliations
          [a ]Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
          [b ]Division of Neurology, Department of Medicine, National University Hospital, Singapore
          [c ]Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
          [d ]Division of Pediatric Endocrinology, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore
          [e ]Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
          [f ]Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
          [g ]Department of Cardiology, National University Heart Centre, Singapore
          [h ]Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
          [i ]Department of Hematology-Oncology, National University Cancer Institute, Singapore
          [j ]Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
          [k ]Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
          Author notes
          [* ]Corresponding author at: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
          Article
          S1201-9712(21)00345-3
          10.1016/j.ijid.2021.04.035
          8056783
          33864917
          5215fb36-d276-437d-b208-3f64b47bba38
          © 2021 The Authors

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          History
          : 30 March 2021
          : 8 April 2021
          : 9 April 2021
          Categories
          Article

          Infectious disease & Microbiology
          hydroxychloroquine,povidone-iodine,zinc,vitamin c,ivermectin,sars-cov-2

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