Worldwide efficacy of bismuth subsalicylate in the treatment of travelers' diarrhea.

So far four randomized studies, three of them double-blind and placebo-controlled, have investigated the role of bismuth subsalicylate (BSS) in the treatment of travelers' diarrhea. When compared with placebo BSS significantly reduced the number of unformed stools and increased the proportion of patients free of symptoms at the end of the trial. In the two studies that compared BSS with loperamide, the latter agent brought significantly faster relief. Diarrhea accompanied by dysenteric symptoms was influenced most favorably by administration of systemic antimicrobial agents. In all four studies only minor adverse effects were noted with BSS or the other active agents. One may include loperamide and a systemic antimicrobial agent in one's travel kit; however, loperamide should not be used for dysentery, and the antimicrobial agent should not be used in uncomplicated cases. As an alternative, although it is less effective, BSS has the unique advantage of being safe enough to use for all patients with travelers' diarrhea.