From the Guidelines
Pepto-Bismol (bismuth subsalicylate) can be used as a second option for prophylaxis in high-risk groups for traveler's diarrhea, but it is not the first-line treatment. According to the most recent guidelines 1, the first-line treatment for traveler's diarrhea depends on the severity of the illness. For moderate to severe diarrhea, antibiotics such as azithromycin or fluoroquinolones are recommended. Bismuth subsalicylate can be used for prophylaxis, but rifaximin is the first choice.
Key Points to Consider
- The standard adult dosage of Pepto-Bismol is two tablets (525 mg) taken four times daily for up to two days.
- Side effects may include temporary darkening of the tongue and stool, and the medication should be avoided by those allergic to aspirin, taking blood thinners, or with bleeding disorders.
- Children, pregnant women, and those with aspirin sensitivity should consult a healthcare provider before use.
- It's essential to stay hydrated by drinking plenty of clean water or oral rehydration solutions.
- If symptoms persist beyond 48 hours, are accompanied by high fever, bloody stools, or severe abdominal pain, medical attention should be sought as antibiotics may be necessary for bacterial infections.
Treatment Approach
The approach to treating traveler's diarrhea should be based on the severity of the illness, as outlined in the guidelines 1. For mild diarrhea, loperamide can be used to manage symptoms. For moderate to severe diarrhea, antibiotics such as azithromycin or fluoroquinolones are recommended. Azithromycin is the first-line agent for dysentery and acute watery diarrhea with greater than mild fever. Rifaximin can be used for non-invasive traveler's diarrhea caused by diarrheagenic E. coli, but it is less effective for invasive pathogens.
Prophylaxis
Prophylaxis should be considered only in high-risk groups, such as those with underlying health conditions or performance-critical occupations/itineraries. Rifaximin is the first choice for prophylaxis, and bismuth subsalicylate is a second option 1. If rifaximin is used as prophylaxis, azithromycin should be provided for standby break-through therapy.
From the FDA Drug Label
Uses relieves Traveler's diarrhea Diarrhea Upset stomach due to overindulgence in food or drink, including: Heartburn Indigestion Nausea Gas Belching Fullness The treatment for traveler's diarrhea using Pepto-Bismol (bismuth subsalicylate) is to take the medication as directed to relieve symptoms.
- Key benefits: relieves traveler's diarrhea, diarrhea, and upset stomach
- Active ingredient: bismuth subsalicylate 2
From the Research
Treatment for Traveler's Diarrhea using Pepto-Bismol (Bismuth Subsalicylate)
- Pepto-Bismol, which contains bismuth subsalicylate, is a commonly used medication for the treatment of traveler's diarrhea 3.
- Bismuth subsalicylate has been shown to be effective in preventing traveler's diarrhea, particularly against enterotoxigenic Escherichia coli-induced diarrhea 4, 5.
- The medication works by reducing the number or multiplication of enterotoxigenic E. coli, and its components have been found to be bactericidal at concentrations possibly attained during clinical trials 4.
- Studies have demonstrated that bismuth subsalicylate can be used as a prophylactic agent against diarrhea, with protection rates of 65% for high-dose and 40% for low-dose regimens 5.
- For the treatment of acute travelers' diarrhea, bismuth subsalicylate has been compared to loperamide, with loperamide being found to be a safe and effective alternative 6.
- However, bismuth subsalicylate may be considered for mild travelers' diarrhea, while antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used for moderate to severe cases 3.
- It is essential to note that the use of bismuth subsalicylate may interact with other medications, such as antidiabetic and antihypertensive drugs, and therefore, caution should be exercised when prescribing this medication, especially for patients with chronic comorbidities 7.