bismuth-subsalicylate and Diarrhea

A large number of studies have evaluated the pharmacology, safety, and/or efficacy of bismuth subsalicylate for the relief of common gastrointestinal symptoms, diarrhea and vomiting due to acute gastroenteritis. In addition, short-term (48 h) medication with bismuth subsalicylate is known to be effective against infectious gastroenteritis such as travelers' diarrhea.. Previous studies have documented the bacteriostatic/bactericidal effects of bismuth subsalicylate against a variety of pathogenic gastrointestinal bacteria. However, meta-analyses of the clinical efficacy of bismuth subsalicylate for both prevention and treatment of travelers' diarrhea have not yet been published.. A total of 14 clinical studies (from 1970s to 2007) comprised the core data used in this assessment of efficacy of bismuth subsalicylate against infectious (including travelers') diarrhea. These studies allowed for statistical meta-analyses regarding prevention (three travelers' diarrhea studies) and treatment of infectious diarrhea (11 studies [five travelers' diarrhea]).. The results show that subjects treated with bismuth subsalicylate for up to 21 days have 3.5 times greater odds of preventing travelers' diarrhea compared with placebo (95% CI 2.1, 5.9; p < 0.001). In addition, subjects with infectious diarrhea treated with bismuth subsalicylate had 3.7 times greater odds of diarrhea relief (recorded on diaries as subjective symptomatic improvement) compared to those receiving placebo (95% CI 2.1, 6.3; p < 0.001).. This systematic review and meta-analysis suggests that bismuth subsalicylate can be beneficial for those at risk or affected by food and waterborne diarrheal disease such as traveler's (infectious) diarrhea, and may decrease the risk of inappropriate antibiotic utilization.

Topics: Bismuth; Communicable Diseases; Diarrhea; Humans; Organometallic Compounds; Salicylates; Travel

Collagenous colitis is a cause of chronic diarrhea. This updated review was performed to identify therapies for collagenous colitis that have been assessed in randomized controlled trials (RCTs).. The primary objective was to assess the benefits and harms of treatments for collagenous colitis.. We searched CENTRAL, the Cochrane IBD Group Specialized Register, MEDLINE and EMBASE from inception to 7 November 2016.. We included RCTs comparing a therapy with placebo or active comparator for the treatment of active or quiescent collagenous colitis.. Data were independently extracted by two authors. The primary outcome was clinical response or maintenance of response as defined by the included studies. Secondary outcome measures included histological response, quality of life and the occurrence of adverse events. Risk ratios (RR) and 95% confidence intervals (CI) were calculated for dichotomous outcomes. The Cochrane risk of bias tool was used to assess bias. The overall quality of the evidence was assessed using the GRADE criteria.. Low quality evidence suggests that budesonide may be effective for inducing and maintaining clinical and histological response in patients with collagenous colitis. We are uncertain about the benefits and harms of therapy with bismuth subsalicylate, Boswellia serrata extract, mesalamine with or without cholestramine, prednisolone and probiotics. These agents and other therapies require further study.

Topics: Bismuth; Boswellia; Budesonide; Cholestyramine Resin; Chronic Disease; Colitis, Collagenous; Diarrhea; Glucocorticoids; Humans; Mesalamine; Organometallic Compounds; Plant Extracts; Prednisolone; Probiotics; Randomized Controlled Trials as Topic; Salicylates

Traveler's diarrhea (TD) is the most common travel-related illness, and it can have a significant impact on the traveler. Pretravel consultation provides an excellent opportunity for the clinician to counsel the traveler and discuss strategies such as food and water hygiene, vaccinations, and medications for prophylaxis or self-treatment that may decrease the incidence and impact of TD. Postinfectious sequelae, such as postinfectious irritable bowel syndrome, reactive arthritis, and Guillain-Barre syndrome, may develop weeks or months after return.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Antidiarrheals; Arthritis, Reactive; Bismuth; Dehydration; Diarrhea; Female; Fluid Therapy; Foodborne Diseases; Guillain-Barre Syndrome; Humans; Immunocompromised Host; Irritable Bowel Syndrome; Organometallic Compounds; Pregnancy; Probiotics; Risk Factors; Salicylates; Travel; Travel Medicine; Vaccines; Waterborne Diseases

It is estimated that approximately 30% to 70% of international travellers will develop diarrhoea during their travels or after returning home.. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute mild-to-moderate diarrhoea in adults from resource-rich countries travelling to resource-poor countries? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 24 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (empirical), antibiotics plus antimotility agents, antimotility agents, bismuth subsalicylate, diet, oral rehydration solutions, and racecadotril for travellers' diarrhoea.

Topics: Anti-Bacterial Agents; Antidiarrheals; Bismuth; Diarrhea; Diet; Fluid Therapy; Humans; Organometallic Compounds; Salicylates; Thiorphan; Travel-Related Illness

Chronic diarrhea is a frequent and challenging problem in clinical medicine. In a considerable subgroup of these, no underlying cause is identified and this is referred to as functional diarrhea. A consensus definition for functional diarrhea is based on loose stool consistency and chronicity and absence of coexisting irritable bowel syndrome. Underlying pathophysiology includes rapid intestinal transit, which may be worsened by stress or be triggered by a preceding infectious gastroenteritis. Diagnostic work-up aims at exclusion of underlying organic disease. Treatment starts with dietary adjustments, aiming at decreasing nutrients that enhance transit and stool and at identifying precipitating food items.

Topics: Antidepressive Agents, Tricyclic; Antidiarrheals; Bismuth; Carbon; Cholestyramine Resin; Chronic Disease; Clonidine; Diarrhea; Humans; Octreotide; Organometallic Compounds; Oxides; Probiotics; Receptors, Opioid; Salicylates; Serotonin 5-HT3 Receptor Antagonists; Thiorphan

Diarrhea is a common clinical feature of inflammatory bowel diseases and may be accompanied by abdominal pain, urgency, and fecal incontinence. The pathophysiology of diarrhea in these diseases is complex, but defective absorption of salt and water by the inflamed bowel is the most important mechanism involved. In addition to inflammation secondary to the disease, diarrhea may arise from a variety of other conditions. It is important to differentiate the pathophysiologic mechanisms involved in the diarrhea in the individual patient to provide the appropriate therapy. This article reviews microscopic colitis, ulcerative colitis, and Crohn's disease, focusing on diarrhea.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antidiarrheals; Bacterial Infections; Biopsy; Bismuth; Blood Cell Count; Blood Chemical Analysis; Body Water; Breath Tests; Budesonide; Cholestyramine Resin; Colitis, Microscopic; Diarrhea; Drug-Related Side Effects and Adverse Reactions; Endoscopy, Gastrointestinal; Feces; Glucocorticoids; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Intestinal Absorption; Intestinal Fistula; Intestinal Mucosa; Intestines; Ion Transport; Malabsorption Syndromes; Medical History Taking; Mesalamine; Organometallic Compounds; Physical Examination; Postoperative Complications; Prednisolone; Salicylates; Sodium; Tumor Necrosis Factor-alpha

Travelers' diarrhea affects more than 10 million people per year and is usually contracted through the ingestion of microbially contaminated food or water. Although most cases resolve in 3 to 5 days, chronic conditions are associated with acute infections. Prevention encompasses avoidance of ingesting contaminated products and, in certain situations, taking prophylactic medications. The available prophylactic antibiotics are very effective in prevention, but are recommended only for specific at-risk individuals and are contraindicated for most travelers.

Topics: Antibiotic Prophylaxis; Antidiarrheals; Bismuth; Diarrhea; Disinfection; Fluid Therapy; Food Contamination; Food Microbiology; Humans; Hygiene; Organometallic Compounds; Risk Factors; Salicylates; Travel; Water Microbiology

Travellers' diarrhoea remains a major public health problem, contributing to significant morbidity and disability. Because bacterial enteropathogens cause a majority of this form of diarrhoea, antibacterial drugs are effective when used in chemoprophylaxis or for empirical treatment.A review of the MEDLINE listings for travellers' diarrhoea for the past 4 years was conducted; a library of >1,000 scientific articles on the topic was also considered in developing this review. Persons who travel from industrialised countries to developing countries of the tropical and semi-tropical world are the individuals who experience travellers' diarrhoea. While diarrhoea occurs with reduced frequency among persons travelling to low-risk areas from other low- or other high-risk areas, and there remain areas of intermediate risk, this review looks primarily at the illness occurring in persons from industrialised regions visiting high-risk regions of Latin America, Africa and Southern Asia. The material reviewed deals with the high frequency of acquiring diarrhoea during international travel to high-risk areas, seen in approximately 40%, and the expected bacterial causes of illness, of which diarrhoeagenic Escherichia coli is the most important. The host risk factors associated with increased susceptibility to diarrhoea include young age, lack of previous travel to high-risk regions in the past 6 months, indiscriminate food and beverage selection patterns, and host genetics. It appears feasible to decrease the rate of illness among the travelling public by careful food and beverage selection or through chemoprophylaxis with nonabsorbed rifaximin. Chemoprophylaxis with rifaximin should help to reduce the occurrence of travellers' diarrhoea and hopefully prevent post-diarrhoea complications, including irritable bowel syndrome. Early empirical therapy with antibacterial drugs, including rifaximin, a fluoroquinolone or azithromycin, will decrease the duration of illness and return travellers more quickly to their planned activities.With collaboration between local governments and public health researchers, it may be possible to improve hygiene in areas to be visited, which may translate into reduced rates of illness. More liberal use of rifaximin prophylaxis is likely to reduce the occurrence of illness and complications of disease. Vaccines and immunoprophylactic products may be beneficial for prevention of a subset of individuals otherwise developing diarrhoea.

Topics: Anti-Bacterial Agents; Antidiarrheals; Azithromycin; Bismuth; Campylobacter; Clinical Trials as Topic; Diarrhea; Drug Resistance, Bacterial; Escherichia coli; Food Microbiology; Humans; Hygiene; Organometallic Compounds; Rifamycins; Rifaximin; Salicylates; Shigella; Travel; Water Microbiology

Diarrhea continues to be the leading health problem among international travelers to developing tropical and semi-tropical regions. Despite more than 50 years of research providing information about the etiology and pathogenesis of the disease, the rate of illness and consequences remain unchanged. An estimated 40% of travelers to developing nations will become ill with diarrhea. Although travelers' diarrhea is considered a self-limited disease, novel and effective approaches to disease prevention and treatment have been realized in recent years. Also, recent evidence has identified a potential for long-term complications of the illness, including postinfectious irritable bowel syndrome. With the advent of poorly absorbed (<0.4%) rifaximin, a treatment option for the common watery diarrhea syndrome equivalent to previously used absorbed antibacterial drugs has emerged. Rifaximin with an excellent safety profile and limited potential to induce coliform resistance, prevents most of the diarrhea that would otherwise occur. With further studies in different settings, new consideration should be given to the routine use of chemoprophylaxis for travelers to high-risk countries. Antibacterial drugs will continue to be the optimal treatment for travelers' diarrhea subjects for the most part caused by bacterial enteropathogens and shorten the duration of diarrhea by 1-2 days compared with no active drug treatment.

Topics: Bismuth; Diarrhea; Fluid Therapy; Humans; Organometallic Compounds; Probiotics; Rifamycins; Rifaximin; Risk Factors; Salicylates; Travel

Collagenous colitis is a disorder that is recognized as a cause of chronic diarrhea. Treatment has been based mainly on anecdotal evidence. This review was performed to identify therapies for collagenous colitis that have been proven in randomized trials.. To determine effective treatments for patients with clinically active collagenous colitis.. Relevant papers published between 1970 and October 2002 were identified via the MEDLINE, PUBMED, and EMBASE databases. Manual searches from the references of identified papers, as well as review papers on collagenous or microscopic colitis were performed to identify additional studies. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. Finally, the Cochrane Controlled Trials Register and the Cochrane Inflammatory Bowel Disease Group Specialized Trials Register were searched for other studies.. Four randomized trials were identified. One trial studied bismuth subsalicylate (published in abstract form only), and 3 trials (1 published in abstract form only) studied budesonide in the therapy of collagenous colitis.. Data were extracted independently by each author onto 2x2 tables (treatment versus placebo and response versus no response). For therapies assessed in one trial only, p-values were derived using the chi-square test. For therapies assessed in more than one trial, summary test statistics were derived using the Peto odds ratio and 95% confidence intervals. Data were combined for analysis only if the outcomes were sufficiently similar in definition.. There were 9 patients with collagenous colitis in the trial studying bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks). Those randomized to active drug were more likely to have clinical (p=0.003) and histological (p=0.003) improvement than those assigned to placebo. A total of 94 patients were enrolled in 3 trials studying budesonide (9 mg daily for 6 to 8 weeks). The pooled odds ratio for clinical response to treatment with budesonide was 12.32 (95% CI 5.53-27.46), with a number needed to treat of 2 patients. There was significant histological improvement with treatment in all 3 trials studying budesonide therapy.. Budesonide is effective in the treatment of collagenous colitis. The evidence for bismuth subsalicylate is weaker, but still important. The roles of these and other therapies in inducing or maintaining remission (as opposed to clinical or histological improvement) of collagenous colitis are unknown.

Topics: Anti-Inflammatory Agents; Bismuth; Budesonide; Chronic Disease; Colitis; Diarrhea; Humans; Organometallic Compounds; Salicylates

Topics: Antibiotic Prophylaxis; Behavior Therapy; Bismuth; Diagnosis, Differential; Diarrhea; Humans; Organometallic Compounds; Salicylates; Travel; Vaccines

Diarrhea represents a major health problem for travelers to developing countries. Although the syndrome is usually self-limited and recovery occurs in the majority of cases without any specific form of therapy, there is a need for safe and effective ways of preventing and treating it. Since the syndrome is most often caused by an infection acquired by ingesting fecally contaminated food or beverages, precautions regarding dietary habits remain the cornerstone of prophylaxis, but dietary self-restrictions do not always translate to reduced rates of diarrheal illness. Administration of probiotics (e.g. lactobacilli or Saccharomyces boulardii) and immunoprophylaxis with the newer oral cholera vaccines have been tried with promising results. Antimicrobials remain, however, the most successful form of prophylaxis, being effective in up to 90% of travelers. For those with impaired health who will take prophylaxis, systemic agents with proved efficacy should be recommended. For other otherwise healthy persons, poorly absorbed agents are preferable in order to avoid the serious, albeit rare, toxicity of systemic drugs. The key factor in the management of acute watery traveler's diarrhea, particularly in infants and young children, is the restoration of water and electrolyte balance. This does not reduce the duration of the illness but will limit dehydration and prevent acidosis. Many patients will require no additional therapy, whereas some will need pharmacologic treatment to shorten the duration of diarrhea or to relieve the accompanying symptoms, like abdominal discomfort, nausea and vomiting. A typical 3- to 5-day illness can be reduced to approximately 1 day by trimethoprim-sulfamethoxazole (TMP-SMX) combination. Some other systemic antimicrobials have been successfully used but, during the last few years, the 4-fluoroquinolone drugs have received considerable attention and have been shown to be highly effective in reducing the duration of traveler's diarrhea. These antimicrobials may become the best option for adults. The safest choice remains the use of poorly absorbed antimicrobials. Unfortunately, however, only a few compounds (i.e. bicozamycin and furazolidone) have been specifically tested in the therapy of traveler's diarrhea. Others (e.g. nifuroxazide or rifaximin), which have been found effective in various homeland forms of infective diarrhea deserve to be evaluated in specifically designed clinical trials. Persons visiting developing countries whe

Topics: Anti-Bacterial Agents; Antibiosis; Antidiarrheals; Bismuth; Clinical Trials as Topic; Diarrhea; Feeding Behavior; Fluid Therapy; Food Microbiology; Humans; Lactobacillus; Organometallic Compounds; Salicylates; Travel; Water Microbiology; Water Supply

Preventing traveler's diarrhea is usually a matter of common sense, good luck, and the host's ability to defend against enteric pathogens, particularly enterotoxigenic Escherichia coli. Untreated tap water, ice cubes, unpasteurized milk products, salads, food from street vendors, and dining in unhygienic-appearing restaurants should be avoided. Well-cooked food that is served hot and carbonated, commercially bottled beverages are usually safe. Food and water precautions, however, are no guarantee of success in preventing traveler's diarrhea. Bismuth subsalicylate used prophylactically is somewhat inconvenient and is only moderately effective. Although antibiotic prophylaxis is very effective for traveler's diarrhea, particularly the quinolones, it should be reserved for high-risk travelers.

Topics: Anti-Bacterial Agents; Bismuth; Diarrhea; Food Microbiology; Humans; Organometallic Compounds; Risk Factors; Salicylates; Travel; Water Microbiology; Water Supply

Travellers' diarrhoea is a common problem worldwide and is likely to continue to increase with the expansion of foreign travel. ETEC is the most frequently isolated enteropathogen although other bacteria, parasites and viruses may be important, depending on the geographic location. New pathogens may well emerge in the future. Prevention must be the ultimate goal but while awaiting effective vaccines we must be content with the traditional dietary advice and its often unpalatable and unacceptable restrictions. Antibiotic prophylaxis is clearly effective but for the present should be restricted to high risk individuals and in those in whom any disruption of a short stay would be critical. For those taking antibiotic prophylaxis advice, as always, should be given regarding the possible adverse effects. Concern about the emergence of resistant strains may be less with the new 4-fluoroquinolone antibiotics. Alternatives for prophylaxis include bismuth subsalicylate which is safe and not an environmental hazard. We must await developments in the Lactobacillus sp. story to see whether the use of probiotics have any role in the prevention of travellers' diarrhoea. Antimotility agents have no place in prophylaxis. The cornerstone of treatment of travellers' diarrhoea is the maintenance of fluid and electrolyte balance. It is particularly important in infants and young children and should be given in the form of oral glucose-electrolyte solutions of which there are many effective preparations. A variety of antibiotics are now known to reduce the duration of travellers' diarrhoea but there is still concern about the risk of therapy for what is usually a minor illness of inconvenience. However, when the loss of 1 or 2 days during a short visit is critical, one could opt for a short course of antibiotics (trimethoprim-sulphamethoxazole, or a 4-fluoroquinolone for 3 days or less) in combination with an antidiarrhoeal trimethoprim alone agent such as loperamide.

Topics: Anti-Bacterial Agents; Bismuth; Diarrhea; Diet; Fluid Therapy; Humans; Organometallic Compounds; Risk Factors; Salicylates; Travel

Bismuth subsalicylate (BSS) has been used for more than 80 years to treat gastrointestinal symptoms although little clinical evidence was available until recently to substantiate its value and possible mechanisms of action. BSS 4.2 g given over 3 1/2 hours was shown to reduce the number of stools passed and favorably alter subjective symptoms in patients with traveler's diarrhea. BSS has also been shown to have beneficial effects on chronic infantile diarrhea. A small but discernible effect has been shown on selected symptoms associated with Norwalk virus-induced gastroenteritis. A liquid preparation, in a dose of 60 ml qid (4.2 g/d), was 62 percent effective in preventing traveler's diarrhea during a three-week period of risk and a tablet formulation (BSS 600 mg qid) was 76 percent effective in preventing experimentally induced enterotoxigenic Escherichia coli diarrhea in volunteers. A tablet formulation (2.1 g/d) was recently shown to be 65 percent effective in preventing traveler's diarrhea during a three-week clinical trial in Mexico. Preliminary evidence suggests that the salicylate moiety exerts antisecretory effects in patients with diarrhea and the bismuth and intestinal hydrolysis products of BSS have direct antimicrobial effects.

Topics: Adolescent; Adult; Bismuth; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Humans; Middle Aged; Organometallic Compounds; Salicylates

Various available forms of therapy can decrease morbidity and mortality associated with acute diarrhea. Oral fluids represent the cornerstone of therapy of all cases. A variety of agents acting nonspecifically can decrease diarrhea and improve other worrisome symptoms associated with enteric infection. Kaopectate makes the stool more formed but has little additional effects. Bismuth subsalicylate, an antisecretory agent, reduces the number of stools passed by about 50 percent and improves other associated symptomatology. The drugs that affect motility such as loperamide and diphenoxylate are the most active of the nonspecifically acting drugs. They must be avoided in patients with significant fever and dysentery. Trimethoprim/sulfamethoxazole is now considered the drug of choice for shigellosis due to the presence of ampicillin-resistant Shigella strains in most regions of the world. Trimethoprim/sulfamethoxazole is also an effective form of therapy for enterotoxigenic Escherichia coli infection and for traveler's diarrhea without definable cause. Erythromycin, although not proved to be effective against Campylobacter, probably shortens the disease. Furazolidone, although not dramatically effective, has a spectrum of activity that includes Shigella, enterotoxigenic E. coli, Campylobacter, and Giardia lamblia. It may not be effective in severely ill (hospitalized) patients with diarrhea. The various forms of available therapy can be administered empirically, depending on symptomatology. Mildly ill patients (one to three unformed stools in 24 hours with minimal additional symptoms) probably are best treated with fluids only. Mild to moderately ill persons (three to six unformed stools in 24 hours) can be treated with a drug that acts nonspecifically, such as bismuth subsalicylate or loperamide. Those with severe diseases (six or more unformed stools with moderate to severe associated symptoms), particularly when associated with fever and the passage of bloody mucoid stools, may be given an antimicrobial agent. The antimicrobial drug given will be determined by ancillary laboratory tests (dark-field examination or examination of a wet-mount preparation for motile Campylobacter or stool culture for Shigella, Campylobacter, or Salmonella) or may be administered on an empiric basis. Traveler's diarrhea can be eliminated in selected persons by the administration of a pharmacologic agent. Liquid bismuth subsalicylate is effective in large doses, which may be impr

Topics: Acute Disease; Adult; Anti-Infective Agents; Bismuth; Campylobacter Infections; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Drug Combinations; Dysentery, Amebic; Dysentery, Bacillary; Escherichia coli Infections; Giardiasis; Humans; Infant; Kaolin; Loperamide; Narcotics; Organometallic Compounds; Parasympatholytics; Pectins; Salicylates; Salmonella Infections; Travel

Three hundred million people, mostly tourists, participate in international travel each year. Development of an acute diarrheal syndrome abroad, while returning home, or shortly after arriving home is referred to as traveler's diarrhea (TD). TD is not a specific diagnosis but, rather, a clinical syndrome with multiple etiologies. In this article, clinical and epidemiological features of TD, specific etiologies and their pathogenesis, as well as current means of diagnosis, treatment, and prevention will be reviewed.

Topics: Anti-Bacterial Agents; Antidiarrheals; Bismuth; Campylobacter Infections; Diarrhea; Diet; Dysentery, Bacillary; Escherichia coli Infections; Fluid Therapy; Giardiasis; Humans; Intestines; Organometallic Compounds; Risk; Salicylates; Salmonella Infections; Time Factors; Travel; Vaccination; Vibrio Infections; Vibrio parahaemolyticus

Many of the 4.5 billion annual episodes of diarrhea are treated unnecessarily with antibiotics; prevalence of antibiotic resistance among diarrheal pathogens is increasing. Knowledge-based antibiotic stewardship interventions typically yield little change in antibiotic use.. To compare antibiotic use among adult outpatients with diarrhea given bismuth subsalicylate (BSS) or placebo.. This randomized clinical trial took place from April to October 2014. Participants were patients aged 15 to 65 years with acute, nonbloody diarrhea from 22 outpatient clinics in Karachi, Pakistan. Participants were interviewed about symptoms and health care utilization during the 5 days after enrollment. Group assignment was concealed from participants, field staff, and the statistician. Primary analysis occurred from August to September 2015.. Participants were randomly assigned (1:1) to receive BSS or placebo for 48 hours or less.. Use of systemic antibiotics within 5 days of enrollment. Secondary outcomes included measures of duration and severity of illness.. Among eligible patients, 39 declined to participate, 440 enrolled, and 1 enrolled participant was lost to follow-up, for a total of 439 patients included in the analysis. Median (interquartile range) participant age was 32 (23-45) years and 187 (43%) were male. Two hundred twenty patients were randomized to BSS and 220 were randomized to placebo. Overall, 54 participants (12%) used systemic antibiotics (16% in the placebo group and 9% in the BSS group); all antibiotic use followed consultation with a physician. Use of any antibiotic was significantly lower in the BSS group (20 of 220 vs 34 of 219 patients; odds ratio [OR], 0.54; 95% CI, 0.30-0.98), as was use of fluoroquinolones (8 of 220 vs 20 of 219 patients; OR, 0.38; 95% CI, 0.16-0.88). Rates of care seeking and hospitalization were similar between groups and no difference was detected in timing of diarrhea resolution. However, those in the BSS group less commonly received intravenous rehydration (14 of 220 vs 27 of 219 patients; OR, 0.48; 95% CI, 0.25-0.95) and missed less work (median [interquartile range], 0 [0-1] vs 1 [0-1] day; P = .04) during follow-up.. This study found less antibiotic use among participants given BSS for acute diarrhea in a setting where antibiotics are commonly used to treat diarrhea. Encouraging health care professionals in such settings to recommend BSS as frontline treatment for adults with diarrhea, and promoting BSS for diarrhea self-management, may reduce antibiotic use and rates of antibiotic resistance globally.. ClinicalTrials.gov identifier: NCT02047162.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antidiarrheals; Antimicrobial Stewardship; Bismuth; Diarrhea; Drug Utilization; Female; Follow-Up Studies; Humans; Inappropriate Prescribing; Logistic Models; Male; Middle Aged; Organometallic Compounds; Pakistan; Practice Patterns, Physicians'; Salicylates; Young Adult

Flushing and gastrointestinal (GI) events are commonly associated with the use of delayed-release dimethyl fumarate (DMF) treatment for relapsing multiple sclerosis.. PREVENT (A Multicenter, Double-Blind, Placebo-Controlled Study of Pepto-Bismol [Bismuth Subsalicylate] on Gastrointestinal Tolerability in Healthy Volunteers Receiving Oral TECFIDERA [Dimethyl Fumarate] Delayed-Release Capsules Twice Daily) is a double-blind, placebo-controlled, 8-week study that evaluated the effect of bismuth subsalicylate on DMF-related GI events. Bismuth subsalicylate 524 mg or placebo were administered 30 min before DMF (weeks 1-4). DMF was dosed twice-daily (BID) at 120 mg (week 1) and 240 mg (weeks 2-8). Using an e-diary device, participants recorded GI and flushing events on the Modified Overall Gastrointestinal Symptom Scale once daily for the preceding 24 h. The primary end point was time to first GI-related event. Secondary end points included frequency and severity of GI-related events.. A total of 175 participants were enrolled (placebo, n = 87; bismuth subsalicylate, n = 88), and 17 discontinued treatment (placebo, n = 8; bismuth subsalicylate n = 9). A total of 146 participants reported ≥1 GI event: placebo, n = 72 (82.8%); and bismuth subsalicylate, n = 74 (84.1%). There was no statistical difference in risk of a GI event between the groups (P = 0.8292). Mean (SD) time from DMF initiation to first GI event was similar: placebo, 5.4 (8.73) days; and bismuth subsalicylate, 5.6 (10.87) days. Incidence of flatulence (38.6% vs 50.6%) and diarrhea (36.4% vs 48.2%) during weeks 1-4 was numerically lower in the bismuth subsalicylate group compared with the placebo group. Mean worst severity scores for flatulence (1.1 vs 1.8; P = 0.0219) and diarrhea (1.0 vs 1.6; P = 0.0500) were lower with bismuth subsalicylate than with placebo.. Although coadministration of bismuth subsalicylate did not affect the occurrence of DMF-related GI events overall, it reduced the severity and incidence of flatulence and diarrhea. ClinicalTrials.gov identifier: NCT01915901.

Topics: Adolescent; Adult; Antidiarrheals; Bismuth; Delayed-Action Preparations; Diarrhea; Dimethyl Fumarate; Double-Blind Method; Drug Therapy, Combination; Female; Flatulence; Healthy Volunteers; Humans; Immunosuppressive Agents; Male; Middle Aged; Multiple Sclerosis, Relapsing-Remitting; Organometallic Compounds; Salicylates; Young Adult

We conducted a randomised single-blinded clinical trial of 100 cholera patients in Port-au-Prince, Haiti to determine if the probiotic Saccharomyces cerevisiae var. boulardii and the anti-diarrhoeal drug bismuth subsalicylate (BS) were able to reduce the duration and severity of cholera. Subjects received either: S. boulardii 250 mg, S. boulardii 250 mg capsule plus BS 524 mg tablet, BS 524 mg, or two placebo capsules every 6 hours alongside standard treatment for cholera. The length of hospitalisation plus the number and volume of emesis, stool and urine were recorded every 6 hours until the study subject was discharged (n = 83), left against medical advice (n = 11), or requested removal from the study (n = 6). There were no reported deaths or adverse study-related events. There were no statistically significant differences between the study arms and the outcomes of interest.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Bismuth; Cholera; Diarrhea; Disease Outbreaks; Emergency Medical Services; Feces; Female; Fluid Therapy; Haiti; Humans; Length of Stay; Male; Organometallic Compounds; Probiotics; Saccharomyces; Salicylates; Severity of Illness Index; Treatment Outcome; Vibrio cholerae

A controlled, randomized, double-blind study in Bangladeshi children (ages 4-36 mo) with acute diarrhoea was undertaken to determine whether bismuth subsalicylate (BSS) would prevent the development of persistent diarrhoea (PD) in young children. The children were randomized to two groups: 226 were given liquid oral BSS, (as Pepto-Bismol), 100 mg/kg/d for 5 d; 225 were given placebo of identical appearance. On admission to the study, the two groups were comparable both clinically and microbiologically. Rotavirus was found in 56% of all the children, and enterotoxigenic E. coli in 31% of a subsample studied. Children treated with BSS had less severe and less prolonged illness than those treated with placebo (p = 0.057). There was, however, no difference in the development of PD between the two groups (8% and 11%). Unexpectedly, patients treated with BSS gained significantly more weight (2.3%) than those treated with placebo (0.5%; p < 0.001) during the course of the study. No toxicity of BSS was detected.. Treatment with BSS had a modest therapeutic effect on acute diarrhoea, as has been previously demonstrated, but with no suggestion of a therapeutic effect on the prevention of persistent diarrhoea in this group of patients.

Topics: Acute Disease; Bismuth; Child, Preschool; Diarrhea; Double-Blind Method; Escherichia coli Infections; Humans; Infant; Organometallic Compounds; Rehydration Solutions; Retroviridae Infections; Salicylates

ORS has led to improved outcome of acute gastroenteritis in both industrialised and developing countries. In both settings there is an increasing demand for active therapy to reduce the duration of diarrhoea and its complications. Persistent diarrhoea is a major consequence of intestinal infections and is responsible for a high number of deaths in poor countries. Bismuth subsalicylate has been used for treatment of acute diarrhoea, with preliminary promising results. In this issue of Acta Paediatrica, a trial with BSS is essential. However the results were marginal and did not justify a mass scale use of BSS, also because of poor cost efficacy rate.

Topics: Acute Disease; Bismuth; Child, Preschool; Diarrhea; Gastroenteritis; Humans; Infant; Organometallic Compounds; Rehydration Solutions; Salicylates

An open-label, parallel comparison of loperamide hydrochloride (Imodium A-D) and bismuth subsalicylate (Pepto-Bismol) was conducted using nonprescription dosages in adult students with acute diarrhea (three or more unformed stools in the preceding 24 hours plus at least one additional symptom of enteric infection). For the two-day study period, the daily dosage was limited to 8 mg (40 ml) for loperamide-treated subjects and to 4.9 g for bismuth subsalicylate-treated subjects. At these dosages, loperamide significantly reduced the average number of unformed bowel movements relative to bismuth subsalicylate. Following the initial dose of treatment, control of diarrhea was maintained significantly longer with loperamide than with bismuth subsalicylate. Time to last unformed stool was significantly shorter with loperamide than with bismuth subsalicylate. In providing overall subjective relief, subjects rated loperamide significantly better than bismuth subsalicylate at the end of the 24 hours. Both treatments were well tolerated, and none of the minor adverse effects reported resulted in discontinuation of therapy. It was concluded that loperamide is effective at a daily dosage limit of 8 mg (40 ml) for the treatment of acute nonspecific diarrhea and provides faster, more effective relief than bismuth subsalicylate.

Topics: Acute Disease; Adult; Bismuth; Clinical Trials as Topic; Diarrhea; Dose-Response Relationship, Drug; Female; Humans; Loperamide; Male; Nonprescription Drugs; Organometallic Compounds; Piperidines; Salicylates

The goals of this study were threefold: to compare the etiology of travelers' diarrhea in West Africa and Mexico, to evaluate two fecal transport systems for the recovery of enteropathogens, and to verify the efficacy of liquid bismuth subsalicylate (BSS) in different locations and under different entrance criteria for disease severity. The study populations consisted of 133 European tourists in West Africa and 112 American students in Mexico who had suffered from travelers' diarrhea. In 60% and 38% of the stool samples at the two study sites, similar proportions of enteropathogens were detected. A two-vial system consisting of Enteric Plus medium and polyvinyl alcohol fixative was slightly superior for identifying enteric pathogens than was a three-vial system with buffered glycerol saline, Cary-Blair medium with campylobacter antibodies, and polyvinyl alcohol fixative. In a parallel, double-blind, randomized trial, BSS significantly shortened disease duration at both study sites.

Topics: Aeromonas; Africa, Western; Animals; Bismuth; Cryptosporidium; Diarrhea; Entamoeba histolytica; Escherichia coli; Feces; Female; Giardia; Humans; Male; Mexico; Organometallic Compounds; Salicylates; Shigella; Specimen Handling; Travel

Bismuth subsalicylate (BSS) has been used for more than 80 years to treat gastrointestinal symptoms although little clinical evidence was available until recently to substantiate its value and possible mechanisms of action. BSS 4.2 g given over 3 1/2 hours was shown to reduce the number of stools passed and favorably alter subjective symptoms in patients with traveler's diarrhea. BSS has also been shown to have beneficial effects on chronic infantile diarrhea. A small but discernible effect has been shown on selected symptoms associated with Norwalk virus-induced gastroenteritis. A liquid preparation, in a dose of 60 ml qid (4.2 g/d), was 62 percent effective in preventing traveler's diarrhea during a three-week period of risk and a tablet formulation (BSS 600 mg qid) was 76 percent effective in preventing experimentally induced enterotoxigenic Escherichia coli diarrhea in volunteers. A tablet formulation (2.1 g/d) was recently shown to be 65 percent effective in preventing traveler's diarrhea during a three-week clinical trial in Mexico. Preliminary evidence suggests that the salicylate moiety exerts antisecretory effects in patients with diarrhea and the bismuth and intestinal hydrolysis products of BSS have direct antimicrobial effects.

Topics: Adolescent; Adult; Bismuth; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Humans; Middle Aged; Organometallic Compounds; Salicylates

Within 48 hours of arrival in Mexico, 182 US students participated in a study to compare the efficacy of two dosages of bismuth subsalicylate (262 mg per tablet) as a prophylactic agent against diarrhea. The students were randomly assigned to receive two tablets (high dose) or one tablet (low dose) of bismuth subsalicylate four times daily or a placebo four times daily during a three-week period. Among these completing the trial, diarrhea (four or more unformed stools in 24 hours or three in eight hours, plus one other symptom) occurred in seven (14%) of 51 receiving the high-dose regimen compared with 15 (24%) of 63 receiving the low-dose regimen and 23 (40%) of 58 in the placebo group. Protection rates were 65% for high-dose and 40% for low-dose bismuth subsalicylate. Diarrhea caused by enterotoxigenic Escherichia coli was found in one student receiving the high-dose regimen, in no students receiving the low-dose regimen, and in seven placebo-treated subjects. Bismuth subsalicylate was well tolerated; the most common side effects were blackening of tongues and stools. Bismuth subsalicylate use in both dosages was associated with tinnitus at a low, clinically insignificant frequency of 1.2 days per 100 days of treatment. The dosage of two tablets of bismuth subsalicylate four times daily (2.1 g/d) appears to be a safe and effective means of reducing the occurrence of travelers' diarrhea among persons at risk for periods up to three weeks.

Topics: Adult; Bismuth; Diarrhea; Humans; Mexico; Organometallic Compounds; Probability; Random Allocation; Salicylates; Tablets; Travel

In a randomized double-blind study, Swiss adults traveling to tropical countries for 12 to 28 days took a solid formulation of bismuth subsalicylate (1.05 or 2.1 g/day on a twice-daily regimen) or placebo. Efficacy was evaluated in 231 volunteers. Diarrheal incidence was reduced by 41% in persons taking the high dose (P = 0.007) and by 35% in those taking the low dose (P = 0.03) with excellent compliance. No serious adverse reactions occurred, but objectionable taste, constipation, and nausea were seen more frequently with active medication (P = 0.04). Twenty patients provided stool samples: no bacteria were detected in the 8 volunteers who were on active medication, but various bacteria were found in 5 of the 12 patients who had taken placebo (P = 0.04).

Topics: Bismuth; Diarrhea; Humans; Organometallic Compounds; Patient Compliance; Salicylates; Salmonella enteritidis; Shigella dysenteriae; Tablets; Travel

Loperamide hydrochloride was compared with bismuth subsalicylate for the treatment of acute nondysenteric travelers' diarrhea in 219 students visiting seven countries in Latin America. Subjects whose condition was not improved with therapy could elect to take trimethoprim-sulfamethoxazole. Persons receiving loperamide passed fewer unformed stools when compared with the bismuth subsalicylate group during the first four hours of therapy, from four to 24 hours, and from 24 to 48 hours after therapy was initiated. Among subjects with disease due to enterotoxigenic Escherichia coli, Shigella sp, other pathogens, and unknown agents, fewer unformed stools were passed by the loperamide-treated subjects than the bismuth subsalicylate-treated subjects for all time periods studied. No significant prolongation of disease was seen in subjects with shigellosis treated with loperamide. Eight of the loperamide-treated subjects experienced constipation compared with one in the bismuth subsalicylate-treated group; otherwise, there was no difference in minor side effects experienced between both treatment groups. We conclude that loperamide is a safe and effective alternative to bismuth subsalicylate for the treatment of nondysenteric travelers' diarrhea.

Topics: Acute Disease; Adult; Antidiarrheals; Bismuth; Diarrhea; Humans; Latin America; Loperamide; Organometallic Compounds; Piperidines; Salicylates; Travel; United States

Various available forms of therapy can decrease morbidity and mortality associated with acute diarrhea. Oral fluids represent the cornerstone of therapy of all cases. A variety of agents acting nonspecifically can decrease diarrhea and improve other worrisome symptoms associated with enteric infection. Kaopectate makes the stool more formed but has little additional effects. Bismuth subsalicylate, an antisecretory agent, reduces the number of stools passed by about 50 percent and improves other associated symptomatology. The drugs that affect motility such as loperamide and diphenoxylate are the most active of the nonspecifically acting drugs. They must be avoided in patients with significant fever and dysentery. Trimethoprim/sulfamethoxazole is now considered the drug of choice for shigellosis due to the presence of ampicillin-resistant Shigella strains in most regions of the world. Trimethoprim/sulfamethoxazole is also an effective form of therapy for enterotoxigenic Escherichia coli infection and for traveler's diarrhea without definable cause. Erythromycin, although not proved to be effective against Campylobacter, probably shortens the disease. Furazolidone, although not dramatically effective, has a spectrum of activity that includes Shigella, enterotoxigenic E. coli, Campylobacter, and Giardia lamblia. It may not be effective in severely ill (hospitalized) patients with diarrhea. The various forms of available therapy can be administered empirically, depending on symptomatology. Mildly ill patients (one to three unformed stools in 24 hours with minimal additional symptoms) probably are best treated with fluids only. Mild to moderately ill persons (three to six unformed stools in 24 hours) can be treated with a drug that acts nonspecifically, such as bismuth subsalicylate or loperamide. Those with severe diseases (six or more unformed stools with moderate to severe associated symptoms), particularly when associated with fever and the passage of bloody mucoid stools, may be given an antimicrobial agent. The antimicrobial drug given will be determined by ancillary laboratory tests (dark-field examination or examination of a wet-mount preparation for motile Campylobacter or stool culture for Shigella, Campylobacter, or Salmonella) or may be administered on an empiric basis. Traveler's diarrhea can be eliminated in selected persons by the administration of a pharmacologic agent. Liquid bismuth subsalicylate is effective in large doses, which may be impr

Topics: Acute Disease; Adult; Anti-Infective Agents; Bismuth; Campylobacter Infections; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Drug Combinations; Dysentery, Amebic; Dysentery, Bacillary; Escherichia coli Infections; Giardiasis; Humans; Infant; Kaolin; Loperamide; Narcotics; Organometallic Compounds; Parasympatholytics; Pectins; Salicylates; Salmonella Infections; Travel

Topics: Bismuth; Clinical Trials as Topic; Diarrhea; Double-Blind Method; Enterotoxins; Escherichia coli; Escherichia coli Infections; Humans; Organometallic Compounds; Salicylates; Travel

The chemoprophylaxis of travellers' diarrhoea by iodochlorhydroxyquinoline combinations, neomycin and phthalsulphathiazole, furazolidone, bismuth salicylates and streptotriad is reviewed. Streptotriad is regarded as a highly effective prophylactic against travellers' diarrhoea. Some elementary food hygiene precautions are detailed.

Topics: Adult; Bismuth; Clioquinol; Diarrhea; Drug Combinations; Drug Therapy, Combination; Furazolidone; Humans; Neomycin; Organometallic Compounds; Salicylates; Streptomycin; Sulfadiazine; Sulfamethazine; Sulfathiazoles; Travel

Enterotoxigenic Escherichia coli cause most traveler's diarrhea in Third World countries. We tested bismuth subsalicylate as prophylactic therapy and as treatment for enterotoxigenic E. coli-induced diarrhea. Thirty-two healthy hospitalized volunteers were challenged orally with enterotoxigenic E. coli, strain H10407 (serotype 078:K80:H11). Administration of 600-mg doses of bismuth subsalicylate or placebo was begun 8 h before bacterial challenge. Doses were taken at 8 h and 2 h before, and at 2 h and 4 h after, the E. coli challenge and were continued four times a day for 3 additional days. The maximum prophylactic bismuth subsalicylate dose was 9.6 g. Those experiencing diarrhea were rerandomized to receive bismuth subsalicylate or placebo, given as 300 mg every 30 min for a total of 2.4 g of bismuth subsalicylate, in eight doses. Diarrhea occurred in 9 of the 16 (56%) subjects receiving placebo and in 2 of the 15 (13%) subjects receiving bismuth subsalicylate, p less than 0.03. This study confirms the effectiveness of bismuth subsalicylate in preventing traveler's (enterotoxigenic E. coli) diarrhea, and shows that bismuth subsalicylate in other than liquid form is effective. Enterotoxigenic E. coli were recovered less frequently from those receiving bismuth subsalicylate than from those receiving placebo, suggesting that bismuth subsalicylate prevents diarrhea by reducing the number or multiplication of enterotoxigenic E. coli. In vitro studies revealed that bismuth subsalicylate and its components each were bactericidal at concentrations possibly attained during the clinical trial.

Topics: Antidiarrheals; Bismuth; Diarrhea; Double-Blind Method; Escherichia coli Infections; Feces; Female; Humans; Male; Organometallic Compounds; Random Allocation; Salicylates; Travel

The efficacy of a daily dosage regimen of subsalicylate bismuth in preventing or reducing the severity of diarrhea among young healthy adults was evaluated in a double-blind, randomized, placebo-controlled trial. Diarrhea developed in 14 (23%) of 62 students receiving subsalicylate bismuth compared with 40 (61%) of 66 students taking a placebo. The protective effect of subsalicylate bismuth was apparent within a day or two of the study onset and became more obvious as the number of days at risk increased. The students treated with subsalicylate bismuth experienced fewer intestinal complaints and were less likely to pass soft or watery stools of any number. Once diarrhea occurred, enteropathogens were less commonly identified in stools of students receiving subsalicylate bismuth (33%) compared with placebo (71%). Subsalicylate bismuth was well tolerated by students during the 21-day trial.

Topics: Adult; Bismuth; Clinical Trials as Topic; Diarrhea; Escherichia coli Infections; Humans; Mexico; Organometallic Compounds; Salicylates; Travel; United States

The location of food consumption was recorded daily for 3 wk by 130 United States summer students newly arrived in Guadalajara, Jalisco, Mexico, as part of an assessment of bismuth subsalicylate vs. placebo in the irevention of travelers' diarrhea. Eating at locations other than homes and apartments (P < 0.025), and specifically at restaurants, was associated with an increased occurrence of diarrhea. Less eating at restaurants (P < 0.005), street vendors (P < 0.005), and school cafeterias (P < 0.01) was associated with reduced occurrence of travelers' diarrhea, even among persons taking bismuth subsalicylate as a preventive measure.

Topics: Bismuth; Diarrhea; Food Contamination; Food Microbiology; Humans; Mexico; Organometallic Compounds; Placebos; Restaurants; Salicylates; Travel; United States

Topics: Aged; Antidiarrheals; Bismuth; Chronic Disease; Colitis, Microscopic; Diagnosis, Differential; Diarrhea; Female; Humans; Intestinal Mucosa; Organometallic Compounds; Salicylates

Topics: Aged, 80 and over; Anemia; Antidiarrheals; Betacoronavirus; Bismuth; Blood Sedimentation; C-Reactive Protein; Coronavirus Infections; Cough; COVID-19; Crohn Disease; Diarrhea; Humans; Lymphopenia; Male; Organometallic Compounds; Pandemics; Pneumonia, Viral; Salicylates; SARS-CoV-2; Treatment Outcome

Recently, I had a visit from a 5-year-old patient who had been given bismuth subsalicylate for a diarrheal illness by a local family physician during a trip to South America. Is this a practice we should encourage?. Research from developing countries has found the use of bismuth subsalicylate to be effective in shortening the duration of diarrheal illness. Despite these findings, its limited effectiveness and concerns about it potentially causing Reye syndrome, compliance, and cost are the key reasons it is not routinely recommended for children.

Topics: Antidiarrheals; Bismuth; Child; Cost-Benefit Analysis; Developing Countries; Diarrhea; Evidence-Based Medicine; Humans; Organometallic Compounds; Reye Syndrome; Salicylates

Topics: Adult; Anti-Bacterial Agents; Antidiarrheals; Atropine; Bismuth; Child; Cross-Sectional Studies; Diarrhea; Diphenoxylate; Drug Combinations; Dysentery; Fluid Therapy; Fluoroquinolones; Humans; Loperamide; Organometallic Compounds; Probiotics; Risk Factors; Salicylates; Travel

Topics: Antibiotic Prophylaxis; Bismuth; Diarrhea; Humans; Organometallic Compounds; Salicylates; Travel

Travelers' diarrhea is the most common health impairment in persons visiting developing countries, affecting 20% to >50% of tourists. Although it is usually benign, travelers' diarrhea represents a considerable socioeconomic burden for both the traveler and the host country. The most common enteropathogens are enterotoxigenic and enteroaggregative Escherichia coli. Travelers' compliance with dietary precautionary measures is poor. Despite the excellent protection rates provided by antibiotics, routine administration of prophylaxis is currently not recommended because of potential adverse reactions. Of the various antibiotics that have been tested, quinolones are considered to be the first choice worldwide; however, quinolone-resistant pathogens are increasingly being isolated. Because it is frequently administered and provides only moderate protection, bismuth subsalicylate is not considered a recommendable option for prophylaxis in Europe, where it is rarely available anyhow. To date, no probiotic has been able to demonstrate clinically relevant protection worldwide. In conclusion, there is no satisfactory prophylactic option, and worldwide monitoring of antimicrobial susceptibility patterns and the search for novel antimicrobial agents, such as nonabsorbed antibiotics, and nonantibiotic medications should continue.

Topics: 4-Quinolones; Anti-Infective Agents; Antibiotic Prophylaxis; Bismuth; Diarrhea; Escherichia coli Infections; Humans; Organometallic Compounds; Probiotics; Salicylates; Travel

Microscopic colitis is a syndrome consisting of chronic watery diarrhea, a normal or near-normal gross appearance of the colonic lining, and a specific histological picture described as either lymphocytic colitis or collagenous colitis. Since its initial descriptions a quarter of a century ago, microscopic colitis has become a frequent diagnosis in patients with chronic diarrhea. Understanding of the cause and pathogenesis of microscopic colitis remain incomplete, but potentially important clues have been discovered that shed light on predisposing factors. In particular, specific HLA-DQ genotypes may be permissive for the development of microscopic colitis, and suggest a linkage to the pathogenesis of celiac sprue. Although the differential diagnosis of chronic watery diarrhea is broad, the diagnosis of microscopic colitis is straightforward, involving endoscopic inspection of the colonic mucosa and proper pathologic interpretation of biopsy specimens. As the limitations of drugs ordinarily used for other forms of inflammatory bowel disease are being recognized, new approaches, such as the use of bismuth subsalicylate, are being evaluated. The prognosis of patients with microscopic colitis syndrome remains good, and symptomatic improvement can be expected in most patients.

Topics: Adult; Bismuth; Chronic Disease; Colitis; Colonoscopy; Diagnosis, Differential; Diarrhea; Female; Humans; Inflammatory Bowel Diseases; Intestinal Mucosa; Organometallic Compounds; Pancreatic Neoplasms; Prognosis; Salicylates; Vipoma

Risk factors for travelers' diarrhea include adventurous behavior, consumption of unclean water or food, and special hosts like those taking long acting H2 blockers. Approaches to prevention include education about risk factors, which often fails to lead to modification of risky behavior, and chemoprophylaxis with bismuth subsalicylate-containing compounds or antimicrobial agents. Chemoprophylaxis is generally discouraged except in special circumstances and in high-risk hosts. Self-treatment of travelers' diarrhea is successful in limiting the course of diarrhea and minimizing losses of vacation and business time. Current therapeutic options, in order of increasing effectiveness, include attapulgite, BSS-containing compounds, loperamide, antimicrobial agents such as the fluoroquinolones, and the combination of loperamide and an antimicrobial agent. Under study are a nonabsorbed antimicrobial agent, rifaximin, and a novel calmodulin inhibitor, zaldaride. Development and evaluation of vaccines against enterotoxigenic Escherichia coli and Shigella are proceeding apace but are not yet available for routine use.

Topics: Antidiarrheals; Bismuth; Diarrhea; Food Microbiology; Humans; Organometallic Compounds; Salicylates; Self Care; Travel; Water Microbiology

Helicobacter pylori infection of the stomach is being detected and treated more often now than ever before. This is likely to result in an increase in complications such as antibiotic-associated diarrhea. However, there is no literature on the incidence of such diarrhea, particularly Clostridium difficile colitis, in patients treated for Helicobacter pylori infection. We report the case of a patient who developed Clostridium difficile colitis after treatment for Helicobacter pylori infection with metronidazole, amoxicillin, H2 blockers, and bismuth subsalicylate. This patient presented with severe diarrhea that responded to a course of metronidazole with rapid disappearance of symptoms. The incidence of Clostridium difficile colitis in patients treated for Helicobacter pylori infection has not been studied. This unique association, although not unexpected, has not yet been reported in the literature. The increasing number of patients being diagnosed and treated for this infection requires a heightened awareness on the part of physicians, to assure early diagnosis and treatment of this treatable, yet potentially dangerous, complication.

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Bismuth; Clostridioides difficile; Diarrhea; Enterocolitis, Pseudomembranous; Female; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Metronidazole; Organometallic Compounds; Penicillins; Salicylates; Stomach Diseases

Known to all as "Montezuma's revenge," "Turista," or the "Aztec two-step," traveler's diarrhea remains the most common and persistent medical complication of international travel. Read on to learn what you need to know about this dreaded condition, especially if your travels this summer will take you beyond the U.S. border.

Topics: Bismuth; Diarrhea; Fluid Therapy; Food Microbiology; Humans; Organometallic Compounds; Risk Factors; Salicylates; Travel; Water Microbiology; Water Supply

The degree of discomfort and inconvenience caused by travelers' diarrhea highlights the need to prepare the international traveler thoroughly. In addition to observing food and water precautions, most travelers should carry antibiotics and antimotility agents to be started if diarrhea occurs. Used judiciously, these precautions may prevent an unplanned tour of bathrooms and outhouses in foreign countries.

Topics: Bismuth; Campylobacter jejuni; Diarrhea; Dysentery, Bacillary; Food Contamination; Giardiasis; Humans; Organometallic Compounds; Rotavirus Infections; Salicylates; Salmonella Infections; Sulfonamides; Travel

Topics: Acquired Immunodeficiency Syndrome; Antidiarrheals; Bismuth; Brain Diseases; Diarrhea; Humans; Intestinal Absorption; Male; Middle Aged; Myoclonus; Organometallic Compounds; Salicylates

Infant mice were used for the evaluation of the efficacy of bismuth subsalicylate (BSS) in the prevention of the growth of Campylobacter jejuni in the intestine. The MIC90 of ten C. jejuni strains was 900 micrograms/ml. Of three dosage regimens tested, continuous treatment before and after the bacterial challenge, mimicking the way BSS is used in the prevention of traveller's diarrhoea, was the most effective. Growth inhibition was dose dependent; the high dose of 2000 micrograms per day was more effective than 300 micrograms per day. After cessation of treatment, campylobacter counts increased to the same level as in the control animals.

Topics: Animals; Animals, Newborn; Bismuth; Campylobacter fetus; Campylobacter Infections; Colony Count, Microbial; Diarrhea; Dose-Response Relationship, Drug; Female; Intestines; Male; Mice; Microbial Sensitivity Tests; Organometallic Compounds; Salicylates

Topics: Bismuth; Diarrhea; Humans; Organometallic Compounds; Salicylates

In view of all the controversy surrounding travelers' diarrhea, how should patients be counseled regarding its prevention and treatment? First, all patients should be instructed on the importance of eating and drinking only safe food and water and on methods of dietary manipulation and oral rehydration therapy. The travelers listed in table 4, as well as short-term visitors to Mexico, may be candidates for prophylactic medication unless such treatment is contraindicated. All patients can be offered an antimotility agent for discriminant use as discussed, and a prescription for trimethoprim-sulfamethoxazole is generally a good idea in the event of a severe bout of illness during travel. A traveler can go overboard in an attempt to avoid diarrheal illness. Such overconcern can detract from the enjoyment of travel and limit the spectrum of activities and cuisine. One report noted that diarrhea seemed to occur more frequently the more a traveler tried to elude it! This could well set the stage for the biggest controversy of all.

Topics: Antidiarrheals; Bismuth; Diarrhea; Doxycycline; Drug Combinations; Food; Humans; Organometallic Compounds; Risk; Salicylates; Sulfamethoxazole; Terminology as Topic; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination

Each year, more than one million American travelers develop diarrhea, usually due to toxin-producing Escherichia coli. Traveler's diarrhea can be prevented with bismuth subsalicylate or doxycycline, but neither is suitable for pediatric patients. Trimethoprim-sulfamethoxazole is effective for prophylaxis and treatment in adults. It is also safe for children and may prove to be efficacious. It may be possible to avoid widespread prophylaxis and to give medication only if diarrhea develops.

Topics: Bismuth; Child; Diarrhea; Doxycycline; Drug Combinations; Escherichia coli Infections; Humans; Organometallic Compounds; Premedication; Salicylates; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bismuth; Diarrhea; Doxycycline; Drug Combinations; Escherichia coli Infections; Humans; Organometallic Compounds; Salicylates; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bismuth; Diarrhea; Humans; Organometallic Compounds; Salicylates; Travel

Topics: Bismuth; Diarrhea; Humans; Hypercalcemia; Organometallic Compounds; Risk; Salicylates; Travel

Topics: Adult; Bismuth; Child; Diarrhea; Humans; Organometallic Compounds; Salicylates; Travel

Topics: Bismuth; Diarrhea; Doxycycline; Drug Combinations; Humans; Organometallic Compounds; Salicylates; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bismuth; Diarrhea; Doxycycline; Fluid Therapy; Humans; Organometallic Compounds; Salicylates; Travel

Topics: Bismuth; Diarrhea; Doxycycline; Humans; Organometallic Compounds; Salicylates; Travel

Topics: Acute Disease; Adult; Bismuth; Diarrhea; Humans; Organometallic Compounds; Salicylates; Travel

Topics: Bismuth; Diarrhea; Humans; Organometallic Compounds; Salicylates; Travel