Bismuth subsalicylate 17.5mg/1ml oral suspension sugar free

Background: Bismuth subsalicylate (BSS), probiotics, rifaximin, and vaccines have been proposed as preventive modalities for patients with travelers’ diarrhea (TD), but their comparative effectiveness for prevention has rarely been studied. We aimed to perform a systematic review and network meta-analysis to test whether one of these modalities is more effective than the others in reducing the incidence of TD. Methods: We searched Pubmed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinical registries from inception of the databases through 18 November 2023, without language restriction, for randomized controlled trials (RCTs) evaluating the efficacy of BSS, probiotics, rifaximin, and vaccines in preventing TD. The primary outcome was the incidence of TD and the safety outcome was the incidence of adverse events. The relative ratio (RR) was used to assess the effect of the modalities, and RR estimates between any two of the modalities were calculated and pooled using a frequentist network meta-analysis model. Results: Thirty-one studies (recruiting 10,879 participants) were included in the analysis. Sixteen were judged to have a low risk of bias. In the aggregate analysis, BSS and rifaximin were more effective than placebo and other treatment modalities, which was further confirmed in the individual analysis. The comparison between rifaximin and placebo achieved high confidence, while the comparisons between BSS and placebo, ETEC and probiotics, and rifaximin and vaccines achieved moderate confidence. BSS had a higher rate of adverse events compared with other treatments. Conclusion: Rifaximin had a relative lower TD incidence and lower adverse event rate, and the evidence was with moderate confidence. Systematic Review Registration: https://osf.io/dxab6 , identifier.

Abstract licence: CC BY

Abstract Potassium-competitive acid blockers (P-CABs) provide potent acid inhibition, yet studies on P-CAB-based quadruple therapy for H. pylori eradication are limited. We theorized that integrating bismuth subsalicylate into a quadruple therapy regimen could enhance eradication rates. However, data on the efficacy of vonoprazan bismuth quadruple therapy are notably scarce. Therefore, the aim of this study was to evaluate the efficacy of vonoprazan-based bismuth quadruple therapy in areas with high clarithromycin and levofloxacin resistance. This was a prospective, single-center, randomized trial conducted to compare the efficacy of 7-day and 14-day vonoprazan-based bismuth quadruple therapy for H. pylori eradication between June 1, 2021, and March 31, 2022. Qualified patients were randomly assigned to the 7-day or 14-day regimen (1:1 ratio by computer-generated randomized list as follows: 51 patients for the 7-day regimen and 50 patients for the 14-day regimen). The regimens consisted of vonoprazan (20 mg) twice daily, bismuth subsalicylate (1024 mg) twice daily, metronidazole (400 mg) three times daily, and tetracycline (500 mg) four times daily. CYP3A4/ 5 genotyping and antibiotic susceptibility tests were also performed. Successful eradication was defined as 13 negative C-UBTs 4 weeks after treatment. The primary endpoint was to compare the efficacy of 7-day and 14-day regimens as first-line treatments, which were assessed by intention-to-treat (ITT) and per-protocol (PP) analyses. The secondary endpoints included adverse effects. A total of 337 dyspeptic patients who underwent gastroscopy were included; 105 patients (31.1%) were diagnosed with H. pylori infection, and 101 patients were randomly assigned to each regimen. No dropouts were detected. The antibiotic resistance rate was 33.3% for clarithromycin, 29.4% for metronidazole, and 27.7% for levofloxacin. The CYP3A4 genotype was associated with 100% rapid metabolism. The H. pylori eradication rates for the 7-day and 14-day regimens were 84.4%, 95% CI 74.3–94.2 and 94%, 95% CI 87.4–100, respectively (RR difference 0.25, 95% CI 0.03–0.53, p value = 0.11). Interestingly, the 14-day regimen led to 100% eradication in the clarithromycin-resistant group. Among the patients in the 7-day regimen group, only two exhibited resistance to clarithromycin; unfortunately, neither of them achieved a cure from H. pylori infection. The incidence of adverse events was similar in both treatment groups, occurring in 29.4% (15/51) and 28% (14/50) of patients in the 7-day and 14-day regimens, respectively. No serious adverse reactions were reported. In conclusion, 14 days of vonoprazan-based bismuth quadruple therapy is highly effective for H. pylori eradication in areas with high levels of dual clarithromycin and levofloxacin resistance.

Abstract licence: CC BY

Background: Although nosocomial diarrhea other than Clostridioides difficile infection (CDI) is common, only limited evidence on antidiarrheal medications has been studied. Probiotics, known for preventing antibiotic-associated diarrhea (AAD) by restoring microbiota and bismuth subsalicylate (BSS), a traditional medication with anti-microbial and anti-secretory effects are interested to be used. We then conducted randomized controlled trial (RCT) to evaluate the use of Saccharomyces boulardii (S. boulardii) versus BSS as an adjunctive treatment for nosocomial diarrhea. Methods: This is a prospective RCT conducted at Department of Medicine, Siriraj Hospital, Bangkok, Thailand. Patients with new onset nosocomial diarrhea and negative C. difficile toxin in stool were randomly allocated to receive 5 days of either S. boulardii (Sb group) or BSS (BSS group), compared to standard care (SC group). Treatment outcomes including stool weight, frequency and consistency were compared between groups. Results: Seventy-two eligible patients were recruited from August 2016 to February 2018. Demographic data in these three groups were comparable. The median changes of stool weight from baseline to day 5 of treatment between the groups were not significantly different (Sb 68 vs. BSS 170 vs. SC 156 g, P=0.11). Median change of stool frequency (Sb 0.9 vs. BSS 1.0 vs. SC 1.6 times/day, P=0.14) and consistency were similar (Sb 0.2 vs. BSS 0.4 vs. SC 0.2, P=0.95). No adverse event was reported. Conclusions: Our study revealed that S. boulardii and BSS added no benefit in treatment of non-CDI nosocomial diarrhea. These were applicable across all outcomes including weight, frequency and consistency of stool. More studies are needed to ascertain a better treatment for nosocomial diarrhea. Trial Registration: Thai Clinical Trials Registry Identifier TCTR20250904004.

Abstract licence: CC BY-NC-ND

Various literature cited suggests that bismuth may have usefulness against Covid-19 both in vitro and in vivo . During the course of caring for Covid-19 patients we administered bismuth subsalicylate to those who displayed diarrhea and/or gastric complaints. Using relatively conservative criteria, upon retrospective review, we noted marked improvement in oxygen requirements in most of the cases. This improvement was observed even when prior therapy with standard anti-Covid drugs had failed. Our overall impression is that these positive results support a detailed evaluation of bismuth as an adjunct treatment for the treatment of Covid-19.

Abstract licence: CC BY

BACKGROUND: Drugs containing bismuth, although usually safe, may rarely cause neurotoxicity. CASE PRESENTATION: We describe the case of a 44-year-old woman treated with bismuth subsalicylate for about 20 years, who developed abnormal behaviour and postural instability in two weeks. On examination, she had greyish discoloration of teeth, was confused and presented generalized myoclonic jerks. In the next days, her clinical condition deteriorated, with a reduction in alertness and more exuberant myoclonus. Brain MRI was unremarkable. CSF revealed mild elevation of protein content (47 mg/dL; reference range: 15-45 mg/dL) and elevation of white blood cell count (10/μL). Bismuth levels in urine (375 μg/L), serum (260 μg/L) and CSF (21.4 μg/L) samples were highly above the threshold for toxicity. Following supportive treatment and bismuth discontinuation, she made a full recovery within weeks. CONCLUSIONS: Although rare, bismuth encephalopathy should be considered in patients presenting with subacute encephalopathy and myoclonus. This encephalopathy can be subacute even after a chronic exposure. Cessation of bismuth can lead to a complete resolution in weeks.

Abstract licence: CC BY

Inflammation-induced oxidative stress in macrophages and microglia is associated with excessive production of reactive oxygen species, initiating a damaging cycle of neuroinflammation and cellular injury. These processes are significant contributors to the pathophysiology of autism spectrum disorders, which involve neuronal dysfunction, cell loss, and behavioral impairments. Under conditions of oxidative stress, activated microglia release pro-inflammatory mediators, further intensifying neuronal damage. Bismuth subsalicylate (BSS), a compound with well-documented anti-inflammatory and antioxidant properties, has shown potential in mitigating such neurodegenerative processes. This study aimed to evaluate the effects of BSS in reducing neuroinflammation and oxidative stress in a propionic acid (PPA)-induced autism model, alongside its impact on behavioral outcomes. The study utilized 30 male Wistar albino rats, with PPA administered intraperitoneally at 250 mg/kg/day for 5 days to induce an autism-like phenotype. Rats were divided into three groups: Group 1 (Normal control, n = 10); Group 2 (PPA + saline, PPAS, n = 10); and Group 3 (PPA + BSS, PPAB, n = 10). Treatments were administered for 15 days. Behavioral performance was assessed through three-chamber sociability, open field, and passive avoidance learning tests, followed by biochemical and histological evaluations of brain tissues. Biochemical analysis revealed a significant increase in malondialdehyde, tumor necrosis factor-alpha, and interleukin-17 levels in the PPAS group, indicating heightened oxidative stress and inflammation. Treatment notably reduced these markers, suggesting its efficacy in mitigating oxidative damage and inflammatory responses. Immunohistochemical results demonstrated reduced glial activation and enhanced neuronal preservation in the hippocampal and cerebellar regions of treated rats. Additionally, behavioral impairments in social interaction, exploration, and memory were significantly improved with BSS therapy. These results suggest that BSS may confer neuroprotective effects through attenuation of oxidative stress and neuroinflammation, potentially contributing to improved neuronal function and behavioral performance in a PPA-induced autism model.

Abstract licence: CC BY