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May Hydrogen Peroxide Reduce The Hospitalization Rate and Complications of SARS-CoV-2 Infection
May Hydrogen Peroxide Reduce The Hospitalization Rate and Complications of SARS-CoV-2 Infection
May hydrogen peroxide reduce the hospitalization rate and complications of SARS-CoV-2 infection?
Arturo Armone Caruso1 M.D., Antonio Del Prete2 M.D., Dr Antonio Ivan Lazzarino3 Ph.D, Roberto
2. Department of Neurosciences and Reproductive and Dentistry Sciences, School of Medicine and Surgery, University
3. EPISTATA – Agency for Clinical Research and Medical Statistics, London, United Kingdom
4. Medical Doctor
5. Pharm-Analysis & Bio-Pharm Laboratory, Department of Pharmacy, School of Medicine and Surgery, University of
Department of Pharmacy
Naples, Italy
coronavirus disease, occurred in Wuhan, China, from December 2019. The current coronavirus
sneeze, droplet inhalation and direct contact of hands with mouth, nose and eyes. In fact, the virus
resides in the mucous membranes and it is transmitted through the saliva and the respiratory
droplets. While prevention of person-to-person transmission is the key to limiting the outbreak, so
far little importance has been given to the events taking place immediately after the onset of the first
For the purpose of preventing the spread of the virus, the Italian government recently (February
2020) issued, among the methods of sanitizing the environments, the use of 0.5% hydrogen
peroxide1. Hydrogen peroxide is already widely used as an environmental, surgical disinfectant and
incubation period of 6.4 days and a base reproduction number of 2.24-3.584. Furthermore, it has
already been proved by scientific studies that the virus persists for two days on the mucous
membranes in macaques5 before the subsequent spread of the virus to the lower respiratory tract.
(e.g. SARS, MERS) on inanimate surfaces by the use of hydrogen peroxide (H2O2) (0.5% in 1
minute) has been already assessed by Kampf et al6. Based on these assumptions, and after an
accurate reviewing of the current the literature concerning hydrogen peroxide, we assumed that
hydrogen peroxide, as antiseptic agent, could play a pivotal role in the reducing of the
hospitalization rate and in the complications of the patients. An antiseptic efficacy versus
SARSCoV-2 can be reasonably hypothesized on oral and nasal mucosa thought the use of hydrogen
peroxide 3% (10 volumes). The action should be not only due to the already known oxidizing and
mechanical removal properties of hydrogen peroxide, but also due to the induction of the innate
antiviral inflammatory response by overexpression of TLR37, thus reducing overall the progression
Therefore, we advise an off-label use of H2O2 3% (10 vol) by nasal and oral washings, carried out
immediately in the time frame after the onset of the first symptoms and the assessed diagnosis of
infection by SARSCoV-2, and however, during the period of illness, in home quarantine or
We propose a regimen of gargling 3 times a day for disinfection of the oral cavity and nasal washes
with nebulizer 2 times a day (due to a greater sensitivity of the nasal mucosa). H2O2 is safe in the
use on the mucous membranes as gargling or as a nasal spray: in fact, it is already commonly used
in otolaryngology. Figure 1 shows the epithelial of oral mucosa treated with H2O2 3% (10 vol) for a
period of six months. As can be seen, no damage was observed on oral mucous membranes and
their microvilli after ongoing gargling treatment with H2O2 3% (10 vol). Furthermore, since another
route for SARSCoV-2 is thought nasolacrimal ducts, we advise the use of iodopovidone 0,5%-
0,6 % as eye drops, due to its antiseptic action within 1 min (5) on SARSCoV-2, 1 drop 3 times a
In our opinion the effectiveness of this regimen will be verified through a significant reduction of
the rate of hospitalization and respiratory complications in patients positive to SARSCoV-2 with
Therefore, we strongly encourage the rapid development of randomized controlled trials in both
SARSCoV-2 positive and negative subjects to study the benefits of H2O2 3% (10 vol) in the
1. Italian Ministry of Health, February the 22th 2020, n° 5443 del 22/02/2020 available at
http://www.data-storage.it/download/2020/coronavirus-circolare_2.pdf
2. Cortelyou PR. Use of peroxide of hydrogen in diseases of the throat and nose. J Med Assoc
3. Urban MV, Rath T, Radtke C. Hydrogen peroxide (H2O2): a review of its use in surgery.
4. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome
5. Liu L, Wei Q, Nishiura K, Peng J, Wang H, Midkiff C, Alvarez X, Qin C, Lackner A, Chen
respiratory mucosal cells drives viral dissemination in rhesus macaques. Mucosal Immunol.
2016;9(4):1089-1101.
surfaces and their inactivation with biocidal agents. Journal of Hospital Infection 2020; 104:
246–251.
double-stranded RNA in airway epithelial cells. Am J Respir Cell Mol Biol. 2010;42:651–
660.
Declarations
Conflicts of Interest: The authors declare that they have no known competing financial interests or
personal relationships that could have appeared to influence the work reported in this paper.
Figure 1. Mouth mucous membranes after administration of H2O2 3% (10 vol) over a period of six
months (Scraping cytology and scanning electron microscopy; SEM 7500 Cambridge MARK 250
SEM).