Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 14 , ISSUE 1 ( January-February, 2022 ) > List of Articles


Prospective Randomized Double-blind Placebo-controlled Study to Assess the Effects of Nano-ozonized Hydrogen Peroxide Nebulization on Results of RTPCR for Novel Coronavirus thus Infectivity and Clinical Course among Moderately Sick COVID-19 Patients Hope in COVID-19 (Hydrogen Peroxide Inhalation)

Prabhat Agrawal, Ashish Gautam, Akhil Pratap Singh, Nikhil Pursnani, Prashant Gupta, Ruchika Garg, Arti Agrawal, Ajeet Singh Chahar

Keywords : COVID-19, Hydrogen peroxide, Nebulization

Citation Information : Agrawal P, Gautam A, Singh AP, Pursnani N, Gupta P, Garg R, Agrawal A, Chahar AS. Prospective Randomized Double-blind Placebo-controlled Study to Assess the Effects of Nano-ozonized Hydrogen Peroxide Nebulization on Results of RTPCR for Novel Coronavirus thus Infectivity and Clinical Course among Moderately Sick COVID-19 Patients Hope in COVID-19 (Hydrogen Peroxide Inhalation). J South Asian Feder Obs Gynae 2022; 14 (1):35-40.

DOI: 10.5005/jp-journals-10006-1986

License: CC BY-NC 4.0

Published Online: 13-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Importance: Given the high mortality and cost of health care, especially in isolation settings, the idea of using nebulized hydrogen peroxide may play a very significant role in inactivation of coronavirus, thus reducing the infectivity period leading to reduced requirement of isolation and improving morbidity and mortality in people suffering with coronavirus disease-2019 (COVID-2019). Aim and objective: Objective of this study was to determine the efficiency of nebulized hydrogen peroxide (H2O2) in reducing the viral load and disease severity of patients suffering with COVID-19. Design: Double-blinded randomized control trial. HOPE in COVID-19 study. Setting: Tertiary care COVID hospital (single center). Participants: Moderate sick COVID-19-positive patients were included in the study after they qualified the inclusion criteria. Intervention: Patients were nebulized using 1 mL of ozonized 3% H2O2 after diluting with 4 mL of normal saline three times a day for 5 days. The control group was nebulized with normal saline only. Main outcome: Outcome was assessed for reduction in oxygen requirement (number of days on oxygen), symptoms resolution (dyspnea, cough, and fever), and number of days it took to be RT-PCR negative for COVID-19. Results: The early data from trial showed promising trends toward a better outcome. The study showed that in the case group who were nebulized with hydrogen peroxide resulted in better outcome in terms of parameters assessed in the study and the differences from the control group were statistically significant (p ≤0.001, CI 95%). Outcome in the form of mortality (odds ratio 0.29, 95% CI 0.02–3.14, p = 0.31, z = 1.007) was statistically insignificant. The number needed to treat for our study was 10.

PDF Share
  1. Coronavirus disease (COVID-19) Situation Report, by WHO published on August 30, 2020.
  2. Available from:, accessed on 30 August.
  3. Huang L, Zhang X, Zhang X, et al. Rapid Asymptomatic Transmission of COVID-19 During the Incubation Period Demonstrating Strong Infectivity in a Cluster of Youngsters Aged 16–23 Years Outside Wuhan and Characteristics of Young Patients with COVID-19: A Prospective Contact-Tracing Study. J Infect 2020;80(6):e1–e13. DOI: 10.1016/j.jinf.2020.03.006.
  4. Schoeman D, Fielding BC. Coronavirus envelope protein: current knowledge. Virol J 16, 69 (2019). Available from:
  5. Foulon F. 2019. Preparing for ASFv: an ‘enveloped virus’. Pig Progress, oct 2.
  6. Zolotarskaia EE, EM Dukhovnaia, RS Dreizin. Studies of the Possibilities of Inactivating Adeno-Associated Virus Type 4. Vopr Virusol 1975; 341–344. Volume 3. PMID: 1162954.
  7. Mentel R, Shirrmakher R, Kevich A, et al. Virus Inactivation by Hydrogen Peroxide. Vopr Virusol 1977;731–733. Volume 6. PMID: 203115.
  8. Podoplekina LE, Shutova NA, Fyodorov YV. Influence of several chemical reagents on lymphocytic choriomeningitis and tacaribe viruses. Virologie 37:43–48. PMID: 3962180.
  9. Sporkenback HJ, Meyer PK, Dernick R. The Virus-Inactivating Effect of Inorganic Peroxy Compounds. Zentralbl Bakteriol Hyg B Ser Umwelthyg Krankenhaushyg Arbeitshyg Praev Med 1987;184:253–261.
  10. Pepose JS, Linette G, Lee SF, et al. Disinfection of Goldman Tonometers Against Human Immunodeficiency Virus Type 1. Arch Ophthalmol 1989;107:983–985. DOI: 10.1001/archopht.1989.01070020045026.
  11. Tyler R, Ayliffe GA, Bradley C. Virucidal Activity of Disinfectants: Studies with Poliovirus. J Hosp Infect 1990;15:339–345. DOI: 10.1016/0195-6701(90)90090-b.
  12. Fox PF, Kosikowski FV. Heat-treated and Hydrogen Peroxide Treated Milks for Ched-dar Cheese. J Dairy Sci 1962;45:648.
  13. Yoshpe-Purer Y, Eylan E. Disinfection of Water by Hydrogen Peroxide. Health Lab Sci 1968;5:233–238. PMID: 4880129.
  14. Toledo RT, Escher FE, Ayres JC. Sporicidal Properties of Hydrogen Peroxide Against Food Spoilage Organisms. Appl Microbiol 1973;26:592–597. PMID: 16349974.
  15. Wardle MD, Renninger GM. Bacterial Effect of Hydrogen Peroxide on Spacecraft Iso-Lates. Appl Microbiol 1975;30:710–711. PMID: 1190768.
  16. Favero MS. Chemical Disinfection of Medical and Surgical Materials. In: Disin- fection, Sterilization, and Preservation. 3rd ed. S. S. Block, ed. Lea and Febiger, Philadelphia, PA.
  17. Turner FJ. 1983. Hydrogen peroxide and other oxidant disinfectants. Pages 240–249 in: Disin- fection, Sterilization, and Preservation. 3rd ed., 469–492, S. S. Block, ed. Lea and Febiger, Philadelphia, PA.
  18. Sheldon BW, Brake J. Hydrogen Peroxide as an Alternative Hatching Egg Disinfectant. Poultry Sci 1991;70:1092–1098.
  19. Rickloff JR, 1988. The Development of Vapor Phase Hydrogen Peroxide as a Sterilization Technology. Presentation at the Health Industry Manufacturers Association Conference. October 30–November 1, Washington, DC.
  20. Klapes AN, Vesley D. Vapor-phase Hydrogen Peroxide as a Surface Decontaminant and Sterilant. Appl Environ Microbiol 1990;56:503–506. PMID: 2106287.
  21. Amanna IJ, Raué HP, Slifka MK. Development of a New Hydrogen Peroxide–Based Vaccine Platform. Nat Med 2012;18(6):974–979. DOI: 10.1038/nm.2763.
  22. Omidbakhsh Navid, Sattar Syed. Broad-spectrum Microbicidal Activity, Toxicologic Assessment, and Materials Compatibility of a New Generation of Accelerated Hydrogen Peroxide-Based Environmental Surface Disinfectant. Am J Infect Control 2006;34: 251–257. DOI: 10.1016/j.ajic.2005.06.002.
  23. Kampf G, Todt D, Pfaender S, et al. Persistence of Coronaviruses on Inanimate Surfaces and Their Inactivation with Biocidal Agents [published correction appears in J Hosp Infect 2020 Jun 17]. J Hosp Infect 2020;104(3):246–251. DOI: 10.1016/j.jhin.2020.01.022.
  24. Blockaid-Disinfection-Information-Sheet-2020-v3.
  25. Urban MV, Rath T, Radtke C. Hydrogen Peroxide (H2O2): A Review of Its Use in Surgery. Wien Med Wochenschr 2019;169:222–225. DOI: 10.1007/s10354-017-0610-2.
  26. Caruso AA, Del Prete A, Lazzarino AI, et al. Might Hydrogen Peroxide Reduce the Hospitalization Rate and Complications of SARS-CoV-2 Infection? [published online ahead of print, 2020 Apr 22]. Infect Control HospEpidemiol 2020;1–2. DOI: 10.1017/ice.2020.170.
  27. Mahler DA, Horowitz MB. Perception of Breathlessness During Exercise in Patients with Respiratory Disease. Med Sci Sports Exerc 1994;26:1078–1081. PMID: 7808239.
  28. Leconte S, Ferrant D, Dory V, et al. Validated Methods of Cough Assessment: A Systematic Review of the Literature. Respiration 2011;81: 161–174. DOI: 10.1159/000321231.
  29. Pedersen S. Inhalers and Nebulizers: Which to Choose and Why. Resp Med 1996;2:69–77. DOI: 10.1016/s0954-6111(96)90201-2.
  30. NianlinXie, MengleiHuan, FengTian, et al. Low Molecular Weight Heparin Nebulization Attenuates Acute Lung Injury. BioMed Res Intl 2017;5. Article ID: 3169179.
  31. Carr J. The Anti-inflammatory Action of Heparin: Heparin as an Antagonist Tohistamine, Bradykinin and Prostaglandin E1. Thromb Res 1979;16(3–4):507–516. DOI: 10.1016/0049-3848(79)90097-5.
  32. Koenig A, Norgard-Sumnicht K, Linhardt R, et al. Differential Interactions of Heparin and Heparan Sulfate Glycosaminoglycans with the Selectins. Implications for the Use of Unfractionated and Low Molecular Weightheparins as Therapeutic Agents. J Clin Invest 1998;101(4):877–889. PMID: 9466983.
  33. Van Haren FMP, Page C, Laffey JG et al. Nebulised Heparin as a Treatment for COVID-19: Scientific Rationale and a Call for Randomised Evidence. Crit Care 2020;24:454. DOI: 10.1186/s13054-020-03148-2.
  34. Yuengsrigul A, Chin T, Nussbaum E. Decreased Cytokine Production from Human Peripheral Blood Mononuclear Cells (pbmcs) by Furosemide. 77. Pediatr Res 1996;39:15. Available from:
  35. Brennecke A, Villar L, Wang Z, et al. Is Inhaled Furosemide a Potential Therapeutic for COVID-19? Am J Med Sci 2020;360(3):216–221. DOI: 10.1016/j.amjms.2020.05.044.
  36. Moghissi K, Dixon K, Gibbins S. Does PDT Have Potential in the Treatment of COVID 19 Patients? [published online ahead of print, 2020 Jun 24]. Photodiagnosis Photodyn Ther 2020;31:101889. DOI: 10.1016/j.pdpdt.2020.101889.
  37. Alamdari DH, Moghaddam AB, Amini S, et al. Application of Methylene Blue-Vitamin C -N-Acetyl Cysteine for Treatment of Critically Ill COVID-19 Patients, Report of a Phase-I Clinical Trial [published online ahead of print, 2020 Aug 20]. Eur J Pharmacol 2020;885:173494. DOI: 10.1016/j.ejphar.2020.173494.
  38. Lansbury L, Lim B, Baskaran V, et al. Co-infections in People with COVID-19: A Systematic Review and Meta-analysis [published online ahead of print, 2020 May 27]. J Infect 2020;S0163–4453(20)30323–30326. DOI: 10.1016/j.jinf.2020.05.046.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.