May 07, 2021

Antibiotic Sinus Rinses (Mupirocin, Betadine, ioRinse)

For patients who suffer from recurrent or persistent sinus infections as well as those wishing to diminish risk of a viral upper respiratory infections, medicated sinus rinses can be performed 1-2 times per day. Under the direction of a physician, such nasal rinses can be performed with betadine or ioRinse antiseptics which have both anti-bacterial as well as anti-viral properties or with prescription bactroban ointment which is effective against bacterial sinus infections. There are numerous other types of antibiotic sinus flushes available, but can only be obtained from compound pharmacies and are often not covered by insurance. Typically, those patients who have had prior sinus surgery benefit greatly from this intervention compared to those who have not.

What's the supporting research?

Published back in 2004, researchers noted that daily saline nasal spray (plain old saltwater) use appears to significantly prevent symptoms of the common cold (which includes coronaviruses) in a population of otherwise healthy adults [link]. Needless to say, one should avoid sharing the same saline nasal spray bottle.

There is also this research that determined 0.23% betadine (aka, providone iodine prep solution) rapidly kills both bacteria and viruses within 15 seconds (in vitro).

Finally, a small study in 2021 suggests that betadine gargles and nasal flushes eradicate COVID in patients who are actively infected within 3 days.

Based on all this data, some ENTs advocate that saline rinses twice a day would probably work better than saline nasal spray. Additionally, adding betadine into the saline mixture might confer additional benefit due to their virucidal effects. A meta-analysis also supported use of betadine in this fashion.

To make your own 1% betadine saline solution to use in the nose whether by spray or rinse, just add 2.4 ml of 10% betadine to 8 ounces (240ml) of saline. Just be aware of a mild temporary nasty aftertaste after using.

There is a stain-free and "better" tasting betadine-like solution called ioRinse. Make sure to get the ENT-specific concentrate formulation. 

Topical preparations to reduce SARS‐CoV‐2 aerosolization in head and neck mucosal surgery. Head & Neck. First published: 25 April 2020. 

Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19. JAMA Otolaryngol Head Neck Surg. Published online February 4, 2021. doi:10.1001/jamaoto.2020.5490 

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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