Betadine for Gargle is something I advice as an ENT surgeon to most of my patients with sore throat.

But why do I love using it?

Betadine gargle is the brand name for Povidone-iodine.  It’s synonymous with “my favorite” gargle.  I have been using it myself and prescribing it for my patients for as long as I can remember.

How does Betadine work?[1,2,3,4]

Povidone Iodine gargle has proven bactericidal and virucidal action both in -vitro and in vivo. There are over sixty years of evidence of efficacy in fighting oral and oropharyngeal germs.

PVP-I gargle inactivate-adenovirus, mumps, rotavirus, poliovirus (types 1 and 3), coxsackievirus, rhinovirus, herpes simplex virus, rubella, measles, influenza, and human immunodeficiency virus.

1% gargle/mouthwash works against MERS-CoV.

Application of PVP-I with 0.23–1% concentration, for 1–2 min reduced SARS-CoV virus infectivity from 1.17 × 106 TCID50/ml to below detectable levels in a study by Kariwa et al. Studies for shorter contact times are not available.

Following the H1N1 swine flu outbreak in 2009, Japan’s Ministry of Health, Labour and Welfare recommended daily gargling as a protective hygiene measure to prevent upper respiratory tract infections.

In patients with chronic respiratory diseases, gargling with PVP-I was found to lower infections with Pseudomonas aeruginosa, Staphylococcus aureus (including MRSA) and Haemophilus influenzae by half .

Oral hygiene using PVP-I will benefit immunocompromised patients at risk of prolonged virus shedding. Prolonged virus shedding increases the potential for antiviral drug resistance and nosocomial transmission and secondary bacterial infection and hospitalization.

Ito et al. reported lowering of viral infectious titres of avian influenza A viruses (H5N1, H5N3, H7N7, and H9N2) to below detectable limits after incubation for only 10 s.

How to use Betadine gargle?

An equal volume of gargle liquid in an equal volume of water preferably warm/.  This helps the povidone-iodine to be in adequate amount to have effective action against the germs in your throat. Gargle for at least 15 seconds.

Betadine has Povidone -Iodine 2% w/v

How does povidone-iodine work?

Povidone-iodine (PVP-I) has a broad-spectrum antimicrobial activity used and known for over 60 years. It also has virucidal actions. It is used in many ways for disinfecting skin, hands, mucosal surfaces, wound treatment, oral and pharyngeal infection. Not only does it help in prevention but it also helps to lower the infectivity period and shedding of germs.

When do you use Betadine gargle for sore throat?

It’s best to start using it as soon you have a hawking sensation scratchy feel postnasal drip or itchy throat.

Sore throat

Throat pain

Together with steam inhalation, it works great in the early stages of cold to kill those viruses.

Acute and chronic pharyngitis

Acute and chronic tonsillitis

Poor oral and dental hygiene

Preoperatively before orotracheal intubation, prevents nosocomial infection.

Postoperatively for maintaining oral hygiene after surgery of oral and oropharyngeal cavity

Povidone-iodine 1% mouthwash also lowers reduces the incidence of dry socket after removal of impacted mandibular third molars.

When to avoid gargling?

When you have associated hoarseness, vigorous gargling can cause more trouble,

Who shouldn’t use it?

If you are allergic to iodine or any other components.

Children often can’t gargle and better avoided.

People with thyroid disorders.

Safety profile

If you are on lithium.

The safety profile of PVP-I is well established. In contrast to other antiseptic agents, PVP-I oral care products do not lead to any irritation or damage of the oral mucosa, even with prolonged use [44, 45]. Although measurable systemic iodine absorption may occur with the long-term use of PVP-I, its clinical manifestation as thyroid dysfunction is not very common [39].

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Why can’t I dilute it more?

It doesn’t work in that case

Does any gargle other than betadine gargle work?

I like a hypertonic saline gargle. But efficacy studies are not comparable.

Take warm water. Dissolve table salt till you can’t dissolve anymore.  That’s hypertonic saline.  Now start gargling with it. It’s better to use betadine gargle though since its evidence-backed.

References:

1 ) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986684/

2)Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions and chemical reagents.
Kariwa H, Fujii N, Takashima I
Dermatology. 2006; 212 Suppl 1():119-23. https://www.ncbi.nlm.nih.gov/pubmed/16490989

3)Ito H, Ito T, Hikida M, et al. Outbreak of highly pathogenic avian influenza in Japan and ant-influenza virus activity of povidone-iodine products. Dermatology. 2006;212(Suppl 1):115–118. doi: 10.1159/000089210.

4)Rapid and Effective Virucidal Activity of Povidone-Iodine Products Against Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Modified Vaccinia Virus Ankara (MVA).
Eggers M, Eickmann M, Zorn J
Infect Dis Ther. 2015 Dec; 4(4):491-501.

5) Japan Ministry of Health, Labour and Welfare. Pandemic influenza preparedness action plan of the Japanese Government. 2007. http://www.mhlw.go.jp/english/topics/influenza/dl/pandemic02.pdf.

6. Silva A, Azevedo M, Sampaio-Maia B, Sousa-Pinto B. The effect of mouthrinses on severe acute respiratory syndrome coronavirus two viral load

: A systematic review. J Am Dent Assoc. 2022 Jul;153(7):635-648.e16. doi: 10.1016/j.adaj.2021.12.007.

Prevention helps. Always.

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