Bismuth subsalicylate
Place in Therapy
Place in Therapy
Bismuth subsalicylate is effective at reducing the incidence of traveler’s diarrhea, as well as the intensity of gastrointestinal symptoms (not associated with diarrhea) in adults travelling to South America as well as Mexico (1). Further, bismuth subsalicylate is effective at reducing the amount of loose stools passed, once traveler’s diarrhea develops, and has shown to reduce the subjective amount of nausea and abdominal pain associated with the diarrhea (2). Thus, bismuth subsalicylate can be effectively utilized for both: the prevention and treatment of mild traveler’s diarrhea (up to 3 bowel movements per day) (3). However, bismuth subsalicylate is not as effective as loperamide at reducing the amount of loose stools (within 0-48hrs of initiation of treatment), decreasing abdominal pain (within the first 24hrs), and for overall amount of relief (4). Of note, there is no difference between bismuth subsalicylate and loperamide on the amount of vomiting and there is conflicting evidence on nausea associated with traveler’s diarrhea (1).
References:
1. Herbert L et al. Symptomatic Treatment of Diarrhea with Bismuth Subsalicylate among Students Attending a Mexican University. Gastroenterology. 1977 Oct, 73:715-8
2. Herbert L.D. et al. Prevention of Traveler’s Diarrhea. Journal of the American Medical Association. 1980; Vol. 243, No.3, 243:237-241
3. Diemert DJ. Prevention and Self-Treatment of Traveler’s Diarrhea. Clin. Microbiol. Rev. 2006 July; 19(3):583-594
4. Johnson P.C. et al. Comparison of Loperamide with Bismuth Subsalicylate for the Treatment of Acute Travelers’ Diarrhea. The Journal of the American Medical Association. 1986, Vol 265, No.6,255:757-760.
Bismuth subsalicylate is effective at reducing the incidence of traveler’s diarrhea, as well as the intensity of gastrointestinal symptoms (not associated with diarrhea) in adults travelling to South America as well as Mexico (1). Further, bismuth subsalicylate is effective at reducing the amount of loose stools passed, once traveler’s diarrhea develops, and has shown to reduce the subjective amount of nausea and abdominal pain associated with the diarrhea (2). Thus, bismuth subsalicylate can be effectively utilized for both: the prevention and treatment of mild traveler’s diarrhea (up to 3 bowel movements per day) (3). However, bismuth subsalicylate is not as effective as loperamide at reducing the amount of loose stools (within 0-48hrs of initiation of treatment), decreasing abdominal pain (within the first 24hrs), and for overall amount of relief (4). Of note, there is no difference between bismuth subsalicylate and loperamide on the amount of vomiting and there is conflicting evidence on nausea associated with traveler’s diarrhea (1).
References:
1. Herbert L et al. Symptomatic Treatment of Diarrhea with Bismuth Subsalicylate among Students Attending a Mexican University. Gastroenterology. 1977 Oct, 73:715-8
2. Herbert L.D. et al. Prevention of Traveler’s Diarrhea. Journal of the American Medical Association. 1980; Vol. 243, No.3, 243:237-241
3. Diemert DJ. Prevention and Self-Treatment of Traveler’s Diarrhea. Clin. Microbiol. Rev. 2006 July; 19(3):583-594
4. Johnson P.C. et al. Comparison of Loperamide with Bismuth Subsalicylate for the Treatment of Acute Travelers’ Diarrhea. The Journal of the American Medical Association. 1986, Vol 265, No.6,255:757-760.