From the Guidelines
Pepto-Bismol (bismuth subsalicylate) is indicated for the prevention and treatment of travelers' diarrhea, as well as for the temporary relief of several digestive issues including diarrhea, upset stomach, indigestion, heartburn, and nausea. The standard adult dose is typically two tablets or 30 mL of liquid every 30-60 minutes as needed, not exceeding 8 doses in 24 hours, for up to 2 days. For children 9-12 years old, the dose is typically one tablet or 15 mL, while it's not recommended for children under 9 without medical advice. Pepto-Bismol works by coating the stomach lining, reducing inflammation, and killing certain bacteria that cause diarrhea.
Key Points to Consider
- Pepto-Bismol may cause temporary darkening of the tongue and stool, and should be avoided by those with aspirin allergies, bleeding disorders, or those taking blood thinners due to its salicylate content 1.
- It should also be avoided by children and teenagers with flu-like symptoms or chickenpox due to the risk of Reye's syndrome.
- If symptoms persist beyond 2 days or are accompanied by high fever or blood in stool, medical attention should be sought.
Evidence-Based Recommendations
- According to the guidelines for the prevention and treatment of travelers' diarrhea, Bismuth subsalicylate (BSS) may be considered for any traveler to prevent travelers’ diarrhea (Strong recommendation, high level of evidence) 1.
- Loperamide is a locally acting opioid receptor agonist that decreases the muscular tone and motility of the intestinal wall, and is effective in reducing diarrhea, but most of the studies have been focused on travelers to resource-challenged countries and the drug was used in combination with antimicrobial agents 1.
- Antimicrobials, such as aztreonam, bicozamycin and rifaximin, that are poorly absorbed, but effective in travelers' diarrhea, may be considered for empirical treatment of secretory/invasive travelers' diarrhea (quinolones first-line, cotrimoxazole second-line) 1.