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Inhalation Formulation & Dosage of PVP Iodine for Respiratory Infections Treatment

The aftermath of the Covid-19 pandemic calls for a rethink of pharmaceutical options for treatment of viral respiratory infections. Respiratory infections start primarily at the surface epithelial cells. Being in permanent direct contact with the ambient air, the respiratory system tissue surface may be amenable to topical treatment approaches. We evaluate and define the method and options of translating effective wound care treatments into the realm of respiratory infections treatment and preventions. The goal is a broad-range, safe and cheap anti-viral respiratory infections medication, which can be made globally available for early-stage home use. In a previous publication we discussed nanoparticles-based formulations. In this article we propose and evaluate a new mode of use of a well-established topical antiseptic – PVP Iodine (PVP-I). In contrast to all previous proposals of PVP-I disinfection nasal sprays or oral gargle, we present a deep and well controlled inhalation protocol to disinfect in one treatment modality both the bronchial tree, upper respiratory nasal and throat tissue simultaneously, using ultrasonic mesh nebulizers. Molecular iodine is quickly absorbed from the lungs and bronchial tree into the blood, within about 10 minutes. Yet, iodine effectively disinfects most viruses within 1 minute, including SARS-CoV-2. Moreover, the slower to absorb PVP-I complex provides a continuously eluting reservoir that maintains the iodine concentration in the airways surface fluids for several hours. These and other factors unique to inhalation are discussed. We provide: (i) Dosage calculation and delivery protocols; (ii) Safety analysis based on guidelines, animal trials and WHO review reports; (iii) Evaluating published pilot clinical trials of SARS-CoV-2 with related nasal spray or oral gargle PVP-I treatments; (iv) Evaluating the potential use and modification of existing off-the-shelf market products to render our proposed treatment immediately available on a global scale. Our recommended formulations comprise of PVP-I at concentrations 0.5% - 5% and pH between pH=6.5 to pH=7.5 (significantly higher than pH~3.5 of present market products). Inhalation dosage of just 0.5 mL may already be effective, which translates to aerosolizing 2 mL with a common nebulizer device. PVP-I is globally available over the counter (OTC). The same is true of ultrasonic nebulizers. In practice, all the ingredients are already globally available to consumers. Hence, we hope health and regulatory authorities worldwide will invest the efforts to establish the validity of the proposed treatment. In the meantime, to prevent confusion or misuse by free-willing users and to facilitate clinical evaluation, we outline a prescription for the proper adaptation use of common commercially available market products. I addition, we propose that the same formulations and protocols can be implemented prophylactically in hospital intensive care units (ICU) for the prevention of ventilator associated pneumonia (VAP).