Information and Clinical Studies on using adjuvant therapy of hydrogen peroxide (H2O2) for COVID-19 patients

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Information and Clinical Studies on using adjuvant therapy of hydrogen peroxide (H2O2) for COVID-19 patients

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Knowledge of the antiseptic effects of hydrogen peroxide (H2O2) dates back to the late 19th century, and its mechanisms of action has been amply described. Globally, many physicians have reported using H2O2 successfully, in different modalities, against COVID-19. Given its anti-infective and oxygenating properties, hydrogen peroxide may offer prophylactic and therapeutic applications for responding to the COVID-19 pandemic. We report a consecutive case series of twenty-three COVID-19 patients (of 36 initially enrolled) who had been diagnosed by their primary care physician (mean age: 39, range: 8 months–70 years; 74% male) and twenty-eight caregivers in the Mexico City Metropolitan Area who received a complementary and alternative medicine (CAM) telemedicine treatment with H2O2 taken by mouth (PO, at a concentration of 0.06%), oral rinse (mouthwash, 1.5%), and/or nebulization (0.2%). We describe the treatment program and report the response of the COVID-19 patients and their caregivers. The patients mainly recovered well, reporting feeling “completely better” at 9.5 days on average. Two (9%) were hospitalized prior to joining the study, and one did not fully recover. Patients frequently reported nausea and sometimes dizziness or vomiting related to the oral treatment. None of the twenty-eight caregivers in close contact with the patients reported contracting COVID-19. Given its low cost and medical potential and considering its relative safety if used properly, we suggest that randomized controlled trials should be conducted. These should include both SARS-CoV-2-positive and SARS-CoV-2-negative participants, with single or combined modes of administration of H2O2, to study the benefits of this simple molecule and offer safe guidance regarding its use by health professionals.


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A case series is described on twenty-three ambulatory patients diagnosed with COVID-19 (coronavirus disease 2019) and monitored by telemedicine, using an adjuvant therapy of hydrogen peroxide (H2O2), administered PO (per orem), by mouth rinses (oral gargles), and by inhalation routes. We report the clinical outcomes of the consecutive COVID-19 patients and their caregivers, who were treated by our medical team between May 11 and July 19, 2020.

Among other things, the team conducted a nonexhaustive review of the scientific literature to identify possible therapeutic and prophylactic alternatives. This review was supplemented by literature from the complementary, traditional, and integrative medicine fields. Our aim was to identify nonstandard therapeutic alternatives for treating viral infections, such as COVID-19, that could be easily and cheaply attained in Mexico over the counter and aid in the primary health response to the pandemic. With these requisites in mind, we identified this clinically useful molecule, hydrogen peroxide.

Dating back to 1888, Love et al. reported the use of hydrogen peroxide as an anti-infectious agent and described it as effective in treating numerous diseases including scarlet fever, diphtheria, runny nose, coryza, whooping cough, asthma, hay fever, and tonsillitis [1]. Specifically for viral diseases that attack the respiratory system, the first reported medical success using hydrogen peroxide therapy dates back exactly 100 years, when doctors Oliver and Murphy reported in The Lancet how they had successfully applied intravenous hydrogen peroxide to treat a group of patients with influenza; they reduced by half the mortality among this group of patients, which consisted of troops from the Indian army during the 1918-1919 Spanish Flu pandemic in the Mesopotamian valley [2].

Although the use of hydrogen peroxide therapeutically has generated great controversy in alternative medicine [3], this ubiquitous molecule is not just one of the many components that help regulate the amount of oxygen that reaches cells, but its presence is vital for a variety of other functions of the body. Many positive effects of hydrogen peroxide on the immune system response have been described, including the stimulation of monocytes and T-helper cells which help fight infections, the increased production of interferon-gamma, which has a role in immunoregulation, and the effect of decreasing the activity of B cells, which have a role in up-regulating the inflammatory response.

Known in medical terms as oxidative therapy or bio-oxidative therapy, hydrogen peroxide is a simple, well-studied, and useful molecule for a range of medical and sanitary applications. Hydrogen peroxide (H2O2) contains one more atom of oxygen than water (H2O) and is naturally produced in the human organism as a by-product of oxygen metabolism. It is metabolized by enzymes known as peroxidases and catalases, which decompose low concentrations of hydrogen peroxide into water and a free oxygen ion. “Hydrogen peroxide appears to be a ubiquitous molecule. We exhale it, excrete it and take it in from diet” [4]. It is produced endogenously for many functions of living organisms, and there is an abundance of scientific knowledge on this molecule, with sufficient documentation on its uses for sanitation, sterilization, and, importantly, diverse therapeutic modalities.

Given that the H2O2 molecule decomposes into water (H2O) and oxygen (O−), in appropriate doses, it is relatively safe for animal and human uses, as well as relatively nontoxic. In the late 1980s, Farr reported that hydrogen peroxide offers therapeutic benefits by directly destroying microorganisms through dual oxidative and oxygenating actions, caused by the released oxygen molecules [5, 6]. In more recent times, hydrogen peroxide has been widely hailed for use in the so-called “oxygenation therapy” in acquired immunodeficiency syndrome (AIDS), several types of cancer, heart and blood vessel diseases, immune disorders, infectious or pulmonary diseases, and many other ailments and conditions.

H2O2 has also been used in dentistry, alone or combined with other salts, since the start of the century [7, 8]. In a recent review, Marshall, Cancro, and Fischman have described scarce side effects on soft tissues after using 1%–1.5% H2O2 as a daily rinse, with over two years of follow-up. They report an in vitro study that found that 3% H2O2 effectively inactivated many virus types, discovering that “coronaviruses and influenza viruses were the most sensitive” [8]. They further state that “since SARS-CoV-2 is vulnerable to oxidation, preprocedural mouth rinses containing oxidative agents such as 1% H2O2 have been suggested to reduce the salivary viral load”.

Brownstein et al. from Wayne State University School of Medicine, who has been applying oxidative therapies for over two decades, recently reported a novel treatment program combining nutritional and oxidative therapies against COVID-19. They used hydrogen peroxide to successfully treat the signs and symptoms of patients diagnosed with COVID-19 [9]. They base their treatments on a combination of oral, intravenous, intramuscular, and nebulized hydrogen peroxide. Their approach has resulted in zero deaths and the recovery of 107 COVID-19 patients [9].

The Food and Drug Administration (FDA) and other official health agencies have also approved the use of hydrogen peroxide as a disinfectant for medical equipment and facilities that have been in contact with the SARS-CoV-2 [10]. In vitro studies demonstrate the efficacy of H2O2 in the vapor phase as a viricide against pathogenic viruses such as SARS-CoV and MERS-CoV [11]. Other studies, regarding viral inactivation in surfaces using diverse disinfectants, including hydrogen peroxide, have also been reported [12, 13].

Recently, the medical hypothesis that hydrogen peroxide is effective against the COVID-19 coronavirus, as well as other viral pathogens and bacteria, has been further advanced [14, 15]. Caruso et al. on the front lines against the COVID-19 outbreaks in Naples, Italy, recommend the need for clinical protocols and research on oxidative therapies regarding COVID-19 [14]. After review of the literature, they propose that the application of hydrogen peroxide to the epithelial cells of the nose, mouth, and throat could well be “extremely effective” against viruses, including SARS-CoV-2 [15]. Gansky's clinical trial at UCSF titled “Effect of antiseptic mouthwash/gargling solutions and pre-procedural rinse on SARS-CoV-2 load” is another example of current research on the subject [16].

The Italian group further proposes that a COVID-19 disinfection regimen by gargling with hydrogen peroxide through mouth rinses (and gargles), two to three times a day, could be useful for the disinfection of COVID-19 from the oral cavity. They also recommended nasal washes with a peroxide nebulizer two times a day. In their opinion, “the effectiveness of hydrogen peroxide-based therapeutic regimen would be verifiable by a significant reduction in the rate of hospitalizations and respiratory complications in patients positive to SARS-CoV-2” [14, 15]. Gansky's clinical trial at UCSF titled “Effect of antiseptic mouthwash/gargling solutions and pre-procedural rinse on SARS-CoV-2 load” is another example of current research on the subject [32].

A further example is Khan et al.'s clinical trial of gargling agents in reducing intraoral viral load among COVID-19 patients based in Pakistan [17]. This quadruple blind trial provides useful information because it is randomized and controlled, and one of their treatments is a 1% hydrogen peroxide gargle. The study design, which includes patients in parallel groups, using diverse types of gargles and nasal lavages, has as outcome measure the intraoral viral load of SARS-CoV-2, and their results will test the hypothesis of H2O2's usefulness for handling the current pandemic, especially in overburdened areas currently suffering consecutive waves of COVID-19 transmission.

Given the public health emergency facing Mexico and what ethics mandate from us as physicians, being aware of the increased demand expected for healthcare services in Mexico [18], as well as the absence of effective and approved therapeutic regimens, we hypothesized that hydrogen peroxide, an antiseptic agent, could play a pivotal role in reducing the severity and duration of the illness in patients and also preventing transmission among caregivers and close contacts. We therefore provided ambulatory treatment using hydrogen peroxide as a complementary therapeutic alternative for twenty-three COVID-19 patients. This treatment was extended in a prophylactic modality to twenty-eight caregivers or persons in close contact with the patients.

Here, we present a case series with our findings and provide some insight and recommendations, which could be useful to the scientific community as an adjuvant treatment during the pandemic's evolution as it affects different countries.

View Studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289588/
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