From the Guidelines
Pepto-Bismol should not be taken for more than 2 days (48 hours) for adults and children 12 years and older. This recommendation is based on the guidelines for adults on self-medication for the treatment of acute diarrhoea, which suggests that bismuth subsalicylate, the active ingredient in Pepto-Bismol, is less effective than loperamide, even in travellers' diarrhoea caused by E. coli 1.
Key Considerations
- The standard adult dosing is typically 2 tablets or 30 mL (2 tablespoons) every 30-60 minutes as needed, not exceeding 8 doses in 24 hours.
- Pepto-Bismol contains bismuth subsalicylate, which can temporarily relieve symptoms like diarrhea, upset stomach, indigestion, and nausea by reducing inflammation in the digestive tract and killing certain bacteria.
- Extended use can lead to side effects including constipation, darkened stools or tongue, and in rare cases, more serious complications.
- If you're taking other medications, especially blood thinners, aspirin, or certain antibiotics, check with your doctor before using Pepto-Bismol as it may interact with these medications.
Special Populations
- For children under 12, consult a doctor before using Pepto-Bismol at all.
- Dosages must be modified for use in children, pregnant and nursing women, and the elderly, as stated in the guidelines for antimicrobials 1.
Important Notes
- If symptoms persist beyond the recommended timeframe, you should discontinue use and consult a healthcare provider as continued digestive issues may indicate a more serious condition requiring medical attention.
- Antimicrobials, such as quinolones, are currently the empirical antimicrobials of choice for dysentery or identified infectious diarrhoea, but Pepto-Bismol is not a substitute for these medications 1.
From the Research
Duration of Pepto Bismol Treatment
- The duration of Pepto Bismol (bismuth subsalicylate) treatment can vary depending on the condition being treated and the individual's response to the medication 2, 3.
- For traveler's diarrhea, studies have shown that treatment with bismuth subsalicylate for up to 21 days can be effective in preventing the condition 4.
- In the treatment of acute diarrhea, bismuth subsalicylate has been shown to be effective for short-term use, typically up to 48 hours 4.
- However, it is recommended that treatment periods with any bismuth-containing compound, including Pepto Bismol, should last no longer than 6-8 weeks, followed by 8-week bismuth-free intervals to minimize the risk of intestinal absorption and sequestration of bismuth in multiple tissue sites 3.
Comparison with Other Treatments
- A study comparing loperamide with bismuth subsalicylate for the treatment of acute traveler's diarrhea found that loperamide was a safe and effective alternative to bismuth subsalicylate, with fewer side effects 5.
- Another study found that bismuth subsalicylate was effective in treating chronic infantile diarrhea and had beneficial effects on selected symptoms associated with Norwalk virus-induced gastroenteritis 2.
Important Considerations
- The salicylate component of bismuth subsalicylate is responsible for its antisecretory effects in patients with diarrhea, while the bismuth component has direct antimicrobial effects 2, 6.
- Bismuth subsalicylate has been shown to be effective in preventing traveler's diarrhea, with a success rate of 62-76% in preventing the condition 2, 4.