SARS-CoV2 InfectionNCT05729204
Washing COVID-19 Away With a Hypertonic Seawater Nasal Irrigation Solution
A study testing Hypertonic seawater solution in people with SARS-CoV2 Infection, run by Larissa University Hospital at 1 site in Greece.
Trial summary
Nasal irrigations are thought to reduce the amount of virus from the nasal cavity. The aim of the present study is to evaluate the effect of a hypertonic seawater solution containing algal and herbal natural ingredients (Sinomarin®) on the nasopharyngeal viral load in hospitalized patients with severe COVID-19… Read more about this study
- Who is it for?
- Ages 18 to 80 years
- Conditions the study is for
- SARS-CoV2 Infection
- What is being tested?
- Hypertonic seawater solution
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 56 participants
- Where
- 1 siteGreece
- Study dates
- 1 Jun 2022to 31 Dec 2022
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- adult patients hospitalized primarily for COVID-19 pneumonia
- confirmed SARS-CoV2 infection diagnosed through RT-PCR test of nasopharyngeal samples
Who cannot join
- patients with confirmed SARS-CoV2 infection who were not primarily admitted for COVID-19 pneumonia
- patients with use of intranasal sprays for at least two weeks prior to study enrollment
- sinonasal surgery within 3 months prior to study enrollment
- patients with sinusitis
- inability to perform nasopharyngeal wash
- participation in other trials
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Washing COVID-19 Away With a Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients
Nasal irrigations are thought to reduce the amount of virus from the nasal cavity. The aim of the present study is to evaluate the effect of a hypertonic seawater solution containing algal and herbal natural ingredients (Sinomarin®) on the nasopharyngeal viral load in hospitalized patients with severe COVID-19 pneumonia. The investigators will conducted a prospective, randomized, controlled trial. Patients will be allocated in two groups, the hypertonic seawater group receiving nasal irrigations with a hypertonic seawater solution (Sinomarin®) every 4 hours during a 16-hour interval per day, for two consecutive days, and the control group (no nasal irrigations). Forty-eight hours after the baseline nasopharyngeal swab (and 8 hours after the last wash in the hypertonic seawater group), a second nasopharyngeal swab will be collected for the semiquantitative estimation of the SARS-CoV-2 viral load as determined by cycle threshold (Ct) values.
Read the detailed description
Investigators will perform a prospective, randomized, controlled study in 56 patients with confirmed COVID-19 pneumonia. All patients will be treated with the standard protocol of care for COVID-19 at the Department of Infectious Diseases and will be randomized into one of two groups with the method of sequentially numbered, opaque, sealed envelopes, the hypertonic seawater group (will receive a hypertonic (2.3% NaCl) seawater solution containing brown algae (Undaria pinnatifida) and blue-green algae (Spirulina platensis) as well as essential oils of Eucalyptus globulus and Mentha spicata, and Thymus vulgaris extract (Sinomarin® Plus Algae Cold \& Flu Relief, Gerolymatos International SA, Krioneri, Greece)) and the control group (no treatment). Sinomarin® is a medical device that utilizes continuous flow diffusion. The solution continues to flow as long as the nozzle is pressed, providing efficient cleansing.
At admission, a baseline nasopharyngeal swab will be collected from all patients and placed in a sterile bottle containing virus transport medium (10 ml tube with 3 ml medium, Biobase, Biodustry, Shandong, China) for SARS-CoV-2 nucleic acid detection (zero hour). Patients in the hypertonic seawater group will be given a review on the proper technique for nasal irrigation. Specifically, they will be instructed to blow their nose before irrigation, gently bend their neck forward, tilt their head to one side, and insert the nozzle into the nostril in line with the nasal septum. They will be advised to press firmly on the nozzle to squirt the solution into the nostril and then repeat the process on the other nostril. The patients will also be instructed to spit out any solution coming into their mouth and then return to an upright position to allow the solution to work for a few seconds before blowing their nose gently. After each use, they will be advised to remove the nozzle from the bottle, wash it thoroughly with warm water, and wipe it dry. Thereafter, patients will be given one bottle of 200 ml Sinomarin® and will be instructed to perform nasal irrigation to each nostril every 4 hours for a 16-hour period per day, for two consecutive days.
Forty-eight hours after the baseline nasopharyngeal swab and 8 hours after the last nasal wash, a second nasopharyngeal swab will be collected for viral load measurement. All nasopharyngeal swabs will be collected by a physician blinded to group allocation and will be collected from the same nostril for each patient.
Demographic data including age, sex, nationality, body mass index, smoking status, and date of admission will be collected at baseline. Data on comorbidities, Charlson comorbidity index, disease related symptoms, vaccination status, presenting day of illness since symptom onset, oxygenation status (PaO2/FiO2), and medication administered will also be recorded. Furthermore, outcome and potential adverse effects related to use of hypertonic seawater solution containing algal and herbal natural ingredients will be recorded. All patients will be followed until hospital discharge, ICU admission, or death. Those that will be discharged will be reexamined 14 days after hospital discharge for real-time polymerase chain reaction (RT-PCR). Manual chart review will be used to gather details of the laboratory studies, course, and outcomes.
- Conditions
- SARS-CoV2 Infection
- Being tested
- Hypertonic seawater solution
- Keywords
- Nasal irrigation, Hypertonic seawater solution, SARS-CoV2, Viral load
- Medical subject headings
- COVID-19
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Hypertonic seawater solutionOther
Also called Sinomarin
Nasal irrigations with hypertonic seawater solution
| Study group | Role | What they receive |
|---|---|---|
| Hypertonic seawater group | Experimental | Patients that will receive nasal irrigations with hypertonic (2.3% NaCl) seawater solution containing brown algae (Undaria pinnatifida) and blue-green algae (Spirulina platensis) as well as essential oils of Eucalyptus globulus and Mentha spicata, and Thymus vulgaris extract (Sinomarin® Plus Algae Cold \& Flu Relief, Gerolymatos International SA, Krioneri, Greece) Receives: Other: Hypertonic seawater solution |
| control group | No intervention | Patients that will not perform nasal irrigations |
What is being measured
The primary outcome is the main question the study is designed to answer.
SARS-CoV2 viral load
SARS-CoV2 viral load in nasopharyngeal swab in hospitalized patients with COVID-19 pneumonia
Measured: 48 hours
Secondary outcomes (1)
Need for escalation to HFNC / NIV, ICU admission
Number of participants with need for escalation to high flow nasal oxygen or non-invasive ventilation or ICU admission in patients with COVID-19 pneumonia.
Measured: From date of randomization until hospital discharge, ICU admission or date of death from any cause, whichever came first assessed up to 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Feb 2023
- Study start1 Jun 2022
- Primary completion30 Nov 2022
- Study completion31 Dec 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for SARS-CoV2 InfectionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Randomized Controlled Trial
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 56 participants (actual)
Sponsor and investigators
- Lead sponsor
- Larissa University Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ioannis Pantazopoulos, Larissa University Hospital
- Investigators
- Ioannis Pantazopoulos, MD, Study director, University Hospital of Larissa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05729204
- Sponsor's protocol ID
- 13149
- Status last verified
- Nov 2023
- First submitted
- 13 Feb 2023
- Last updated
- 3 Nov 2023
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: All collected individual participant data (IPD)
Publications
Pantazopoulos I, Chalkias A, Mavrovounis G, Dimeas I, Sinis S, Miziou A, Rouka E, Poulas K, Gourgoulianis K. Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial. Can Respir J. 2022 Sep 27;2022:8794127. doi: 10.1155/2022/8794127. eCollection 2022.
PubMed 36247079Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W, Snidvongs K. Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis. Am J Rhinol Allergy. 2018 Jul;32(4):269-279. doi: 10.1177/1945892418773566. Epub 2018 May 18.
PubMed 29774747Kwon PS, Oh H, Kwon SJ, Jin W, Zhang F, Fraser K, Hong JJ, Linhardt RJ, Dordick JS. Sulfated polysaccharides effectively inhibit SARS-CoV-2 in vitro. Cell Discov. 2020 Jul 24;6(1):50. doi: 10.1038/s41421-020-00192-8. eCollection 2020. No abstract available.
PubMed 32714563Pradhan B, Nayak R, Patra S, Bhuyan PP, Behera PK, Mandal AK, Behera C, Ki JS, Adhikary SP, MubarakAli D, Jena M. A state-of-the-art review on fucoidan as an antiviral agent to combat viral infections. Carbohydr Polym. 2022 Sep 1;291:119551. doi: 10.1016/j.carbpol.2022.119551. Epub 2022 May 2.
PubMed 35698330Huijghebaert S, Hoste L, Vanham G. Essentials in saline pharmacology for nasal or respiratory hygiene in times of COVID-19. Eur J Clin Pharmacol. 2021 Sep;77(9):1275-1293. doi: 10.1007/s00228-021-03102-3. Epub 2021 Mar 27.
PubMed 33772626Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Sci Rep. 2019 Jan 31;9(1):1015. doi: 10.1038/s41598-018-37703-3.
PubMed 30705369Slapak I, Skoupa J, Strnad P, Hornik P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg. 2008 Jan;134(1):67-74. doi: 10.1001/archoto.2007.19.
PubMed 18209140Gangadi M, Georgiou S, Moschotzopoulou E, Antronikou T, Kainis E, Alevizopoulos K. Efficacy and safety of a hypertonic seawater nasal irrigation solution containing algal and herbal natural ingredients in patients with COVID-19. Eur Rev Med Pharmacol Sci. 2022 Dec;26(2 Suppl):112-123. doi: 10.26355/eurrev_202212_30495.
PubMed 36524919
Study at a glance
From the registry record, last updated by the sponsor on 3 Nov 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Washing COVID-19 Away With a Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients
- ClinicalTrials.gov ID
- NCT05729204
- Acronym / sponsor ID
- 13149
- Conditions
- SARS-CoV2 Infection
- Keywords
- Nasal irrigation, Hypertonic seawater solution, SARS-CoV2, Viral load
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 56 participants (actual)
- Lead sponsor
- Larissa University HospitalUniversity, hospital or other
- Study start
- 1 Jun 2022 (actual)
- Primary completion
- 30 Nov 2022 (actual)
- Study completion
- 31 Dec 2022 (actual)
- First posted
- 15 Feb 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Nasal irrigations are thought to reduce the amount of virus from the nasal cavity. The aim of the present study is to evaluate the effect of a hypertonic seawater solution containing algal and herbal natural ingredients (Sinomarin®) on the nasopharyngeal viral load in hospitalized patients with severe COVID-19 pneumonia. The investigators will conducted a prospective, randomized, controlled trial. Patients will be allocated in two groups, the hypertonic seawater group receiving nasal irrigations with a hypertonic seawater solution (Sinomarin®) every 4 hours during a 16-hour interval per day, for two consecutive days, and the control group (no nasal irrigations). Forty-eight hours after the baseline nasopharyngeal swab (and 8 hours after the last wash in the hypertonic seawater group), a second nasopharyngeal swab will be collected for the semiquantitative estimation of the SARS-CoV-2 viral load as determined by cycle threshold (Ct) values.
Detailed description
Investigators will perform a prospective, randomized, controlled study in 56 patients with confirmed COVID-19 pneumonia. All patients will be treated with the standard protocol of care for COVID-19 at the Department of Infectious Diseases and will be randomized into one of two groups with the method of sequentially numbered, opaque, sealed envelopes, the hypertonic seawater group (will receive a hypertonic (2.3% NaCl) seawater solution containing brown algae (Undaria pinnatifida) and blue-green algae (Spirulina platensis) as well as essential oils of Eucalyptus globulus and Mentha spicata, and Thymus vulgaris extract (Sinomarin® Plus Algae Cold \& Flu Relief, Gerolymatos International SA, Krioneri, Greece)) and the control group (no treatment). Sinomarin® is a medical device that utilizes continuous flow diffusion. The solution continues to flow as long as the nozzle is pressed, providing efficient cleansing.
At admission, a baseline nasopharyngeal swab will be collected from all patients and placed in a sterile bottle containing virus transport medium (10 ml tube with 3 ml medium, Biobase, Biodustry, Shandong, China) for SARS-CoV-2 nucleic acid detection (zero hour). Patients in the hypertonic seawater group will be given a review on the proper technique for nasal irrigation. Specifically, they will be instructed to blow their nose before irrigation, gently bend their neck forward, tilt their head to one side, and insert the nozzle into the nostril in line with the nasal septum. They will be advised to press firmly on the nozzle to squirt the solution into the nostril and then repeat the process on the other nostril. The patients will also be instructed to spit out any solution coming into their mouth and then return to an upright position to allow the solution to work for a few seconds before blowing their nose gently. After each use, they will be advised to remove the nozzle from the bottle, wash it thoroughly with warm water, and wipe it dry. Thereafter, patients will be given one bottle of 200 ml Sinomarin® and will be instructed to perform nasal irrigation to each nostril every 4 hours for a 16-hour period per day, for two consecutive days.
Forty-eight hours after the baseline nasopharyngeal swab and 8 hours after the last nasal wash, a second nasopharyngeal swab will be collected for viral load measurement. All nasopharyngeal swabs will be collected by a physician blinded to group allocation and will be collected from the same nostril for each patient.
Demographic data including age, sex, nationality, body mass index, smoking status, and date of admission will be collected at baseline. Data on comorbidities, Charlson comorbidity index, disease related symptoms, vaccination status, presenting day of illness since symptom onset, oxygenation status (PaO2/FiO2), and medication administered will also be recorded. Furthermore, outcome and potential adverse effects related to use of hypertonic seawater solution containing algal and herbal natural ingredients will be recorded. All patients will be followed until hospital discharge, ICU admission, or death. Those that will be discharged will be reexamined 14 days after hospital discharge for real-time polymerase chain reaction (RT-PCR). Manual chart review will be used to gather details of the laboratory studies, course, and outcomes.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Randomized Controlled Trial
| Arm | Type | Receives |
|---|---|---|
| Hypertonic seawater group | Experimental | Other: Hypertonic seawater solutionPatients that will receive nasal irrigations with hypertonic (2.3% NaCl) seawater solution containing brown algae (Undaria pinnatifida) and blue-green algae (Spirulina platensis) as well as essential oils of Eucalyptus globulus and Mentha spicata, and Thymus vulgaris extract (Sinomarin® Plus Algae Cold \& Flu Relief, Gerolymatos International SA, Krioneri, Greece) |
| control group | No intervention | –Patients that will not perform nasal irrigations |
Who may qualify
- Ages
- 18 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- adult patients hospitalized primarily for COVID-19 pneumonia
- confirmed SARS-CoV2 infection diagnosed through RT-PCR test of nasopharyngeal samples
Key exclusion criteria (6 listed)
- patients with confirmed SARS-CoV2 infection who were not primarily admitted for COVID-19 pneumonia
- patients with use of intranasal sprays for at least two weeks prior to study enrollment
- sinonasal surgery within 3 months prior to study enrollment
- patients with sinusitis
- inability to perform nasopharyngeal wash
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Hypertonic seawater solutionAlso: SinomarinNasal irrigations with hypertonic seawater solution | Other | Hypertonic seawater group |
Primary outcome
SARS-CoV2 viral load
Time frame: 48 hours
SARS-CoV2 viral load in nasopharyngeal swab in hospitalized patients with COVID-19 pneumonia
1 secondary outcome
Need for escalation to HFNC / NIV, ICU admission
Time frame: From date of randomization until hospital discharge, ICU admission or date of death from any cause, whichever came first assessed up to 3 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Nov 2023.
- Background: PubMed 36247079Pantazopoulos I, Chalkias A, Mavrovounis G, Dimeas I, Sinis S, Miziou A, Rouka E, Poulas K, Gourgoulianis K. Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial. Can Respir J. 2022 Sep 27;2022:8794127. doi: 10.1155/2022/8794127. eCollection 2022.
- Background: PubMed 29774747Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W, Snidvongs K. Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis. Am J Rhinol Allergy. 2018 Jul;32(4):269-279. doi: 10.1177/1945892418773566. Epub 2018 May 18.
- Background: PubMed 32714563Kwon PS, Oh H, Kwon SJ, Jin W, Zhang F, Fraser K, Hong JJ, Linhardt RJ, Dordick JS. Sulfated polysaccharides effectively inhibit SARS-CoV-2 in vitro. Cell Discov. 2020 Jul 24;6(1):50. doi: 10.1038/s41421-020-00192-8. eCollection 2020. No abstract available.
- Background: PubMed 35698330Pradhan B, Nayak R, Patra S, Bhuyan PP, Behera PK, Mandal AK, Behera C, Ki JS, Adhikary SP, MubarakAli D, Jena M. A state-of-the-art review on fucoidan as an antiviral agent to combat viral infections. Carbohydr Polym. 2022 Sep 1;291:119551. doi: 10.1016/j.carbpol.2022.119551. Epub 2022 May 2.
- Background: PubMed 33772626Huijghebaert S, Hoste L, Vanham G. Essentials in saline pharmacology for nasal or respiratory hygiene in times of COVID-19. Eur J Clin Pharmacol. 2021 Sep;77(9):1275-1293. doi: 10.1007/s00228-021-03102-3. Epub 2021 Mar 27.
- Background: PubMed 30705369Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Sci Rep. 2019 Jan 31;9(1):1015. doi: 10.1038/s41598-018-37703-3.
- Background: PubMed 18209140Slapak I, Skoupa J, Strnad P, Hornik P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg. 2008 Jan;134(1):67-74. doi: 10.1001/archoto.2007.19.
- Background: PubMed 36524919Gangadi M, Georgiou S, Moschotzopoulou E, Antronikou T, Kainis E, Alevizopoulos K. Efficacy and safety of a hypertonic seawater nasal irrigation solution containing algal and herbal natural ingredients in patients with COVID-19. Eur Rev Med Pharmacol Sci. 2022 Dec;26(2 Suppl):112-123. doi: 10.26355/eurrev_202212_30495.
- Individual participant dataSharing planned: Yes. All collected individual participant data (IPD)
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Ioannis Pantazopoulos, MD study director
University Hospital of Larissa
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Hypertonic seawater solution in people with SARS-CoV2 Infection, run by Larissa University Hospital at 1 site in Greece.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 3 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Greece. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
SARS-CoV2 viral load (time frame: 48 hours). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05729204, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Nov 2023.