Huijghebaert S, Fabbris C, Baxter A L, Parviz S, Chatterjee U S, Rabago D
Pharmaceutical Science, Non-Profit Research, Antwerp, Belgium.
ENT Unit, Department of Surgery, Ospedali Riuniti Padova Sud, Padova, Italy.
Front Public Health. 2025 Aug 20;13:1462286. doi: 10.3389/fpubh.2025.1462286. eCollection 2025.
The World Health Organization recommends at-home management of mild COVID-19. While our preliminary evaluation provided evidence for saline nasal irrigation (SNI) and gargling in COVID-19, an update and risk-benefit assessment for self-care in Omicron infection is warranted, from treatment and preparedness perspectives, as new SARS-CoV-2 variants continuously emerge, while symptoms overlap with those of common colds and other upper respiratory tract infections.
Systematic literature searches for preclinical and clinical studies involving Omicron infection and saline, bias assessment, and review of outcomes (benefits, risks).
A total of 14 studies met eligibility criteria: one experimental proof-of-concept study, eight randomized clinical trials (RCTs), two quasi-experimental, two matched case-control, and one controlled study (2,389 patients, 1,101 receiving saline). Study designs were highly heterogeneous, not allowing pooling of the data. In line with the pre-clinical findings, the clinical trials showed lower viral loads or faster viral clearance with SNI use; results were consistent, if SNI was started early in the infection. Individual studies supported reduced infectivity of saliva, inflammatory mediators and C-reactive protein, and increased lymphocytes. Symptoms resolved faster if severe at baseline, in line with the findings from pre-Omicron RCTs; the ability to perform daily activities was assessed in one RCT and improved significantly. Early initiation of daily SNI/gargling before the onset of smell/taste dysfunction prevented their development. Daily SNI hygiene was also associated with less frequent development of fever and a shorter duration of fever than observed among (non-irrigating) controls. Daily SNI modestly helped to reduce household transmission; a preliminary report suggests that reliable prophylaxis can be achieved, provided daily SNI is combined with strict use of personal protective measures. Hospitalization was virtually absent. Isotonic SNI was best tolerated.
This analysis is consistent with prior review findings: early initiation of SNI/gargling may help patients with mild COVID-19 feel better, irrespective of the variant. If clean water and irrigation materials are provided, SNI can reasonably be recommended as early self-care for COVID-19, as it is for the common cold. Larger prospective studies are required to determine optimal protocols and SNI's potential role in respiratory pathogen pandemic preparedness.
世界卫生组织建议对轻症新冠病毒感染进行居家管理。虽然我们的初步评估为新冠病毒感染中的鼻腔盐水冲洗（SNI）和漱口提供了证据，但鉴于新的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变种不断出现，且症状与普通感冒和其他上呼吸道感染的症状重叠，从治疗和防范角度出发，对奥密克戎感染的自我护理进行更新及风险效益评估是必要的。
系统检索涉及奥密克戎感染和盐水的临床前和临床研究，进行偏倚评估，并审查结果（益处、风险）。
共有14项研究符合纳入标准：1项实验性概念验证研究、8项随机临床试验（RCT）、2项准实验研究、2项配对病例对照研究和1项对照研究（2389例患者，1101例接受盐水治疗）。研究设计高度异质性，无法合并数据。与临床前研究结果一致，临床试验表明使用SNI可降低病毒载量或加快病毒清除；如果在感染早期开始使用SNI，结果是一致的。个别研究支持唾液传染性降低、炎症介质和C反应蛋白减少以及淋巴细胞增加。如果基线时症状严重，症状缓解更快，这与奥密克戎之前的RCT研究结果一致；一项RCT评估了日常活动能力，结果显示有显著改善。在嗅觉/味觉功能障碍出现之前尽早开始每日SNI/漱口可预防其发生。与（未冲洗的）对照组相比，每日SNI卫生措施还与发热频率降低和发热持续时间缩短有关。每日SNI适度有助于减少家庭传播；一份初步报告表明，如果每日SNI与严格使用个人防护措施相结合，可实现可靠的预防。几乎没有住院情况。等渗SNI耐受性最佳。
该分析与先前的综述结果一致：尽早开始SNI/漱口可能有助于轻症新冠病毒感染患者感觉更好，无论病毒变种如何。如果提供清洁水和冲洗材料，SNI可合理地作为新冠病毒感染的早期自我护理方法推荐，就像对普通感冒一样。需要更大规模的前瞻性研究来确定最佳方案以及SNI在呼吸道病原体大流行防范中的潜在作用。
