Bismuth subsalicylate 262.5mg chewable tablets 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 4.0

BackgroundSmall intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) are common gastrointestinal disorders that significantly impact patients' quality of life and pose a financial burden on healthcare systems. SIBO is characterized by an abnormal increase in small intestinal bacteria, leading to symptoms such as malabsorption, diarrhea, bloating, and abdominal pain. IBS is a functional gastrointestinal disorder marked by recurrent abdominal pain with changes in bowel habits, and is subclassified into diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C), and mixed-type IBS. Notably, SIBO and IBS-particularly IBS-D-often present with overlapping symptoms. Antibiotics such as Metronidazole, Bismuth, and Rifaximin are commonly used to treat both conditions; however, their comparative efficacy and safety remain unclear.AimTo analyze and compare the role of Metronidazole, Bismuth, Rifaximin for improvement of SIBO and IBS.MethodsA systematic review was performed on the databases PubMed and Cochrane Library, spanning from 2000 to 2023. Studies eligible for inclusion were observational studies or randomized controlled trials (RCTs) performed on human subjects that examined the use of Metronidazole, Bismuth, or Rifaximin in the management of SIBO and IBS. Two independent reviewers performed data extraction, and resolved discrepancies by consensus. The data extracted consisted study characteristics, patient demographics, intervention details, and outcome measured. Key references were verified and prioritized using Reference Citation Analysis to ensure contemporary relevance and citation impact.ResultsA total of 55 studies, including RCTs and observational studies, met inclusion criteria and were analyzed. These studies assessed the efficacy and safety of Metronidazole, Bismuth, and Rifaximin in patients with SIBO and IBS. Rifaximin demonstrated the most consistent efficacy across both conditions, particularly in IBS-D and mild to moderate SIBO, with a low incidence of adverse events (16.7%). Metronidazole showed moderate efficacy, with some benefit in IBS-C and mild SIBO, but was associated with a higher rate of gastrointestinal side effects (16.6%). Bismuth offered symptom relief in IBS, especially for bloating and diarrhea, though its effectiveness was generally lower than the other agents. Subgroup analyses suggested differential efficacy by IBS subtype and SIBO severity, supporting the potential role of clinical phenotype in guiding antibiotic selection.ConclusionSignificant clinical efficacy was shown by the drug Rifaximin among IBS-D patients at reducing symptoms, with minimal undesirable adverse effects and a favorable safety profile. Metronidazole was effective in treating SIBO but was generally associated with a higher prevalence of gastrointestinal side effects than the other drugs. However, Bismuth generally proved to be effective on isolated levels, especially in combination regimes where it showed its efficacy levels to be less pronounced relative to Rifaximin as well as Metronidazole. Further studies are needed to optimize treatment strategies and clarify the comparative long-term benefits and risks of these therapies.

Abstract licence: CC BY-NC

ObjectiveHelicobacter pylori (H. pylori) infection represents a global health challenge. This study aimed to evaluate the effect of probiotic supplementation on the efficacy and safety of bismuth-containing quadruple therapy (BQT) for H. pylori eradication.MethodsRandomized controlled trials (RCTs) meeting the eligibility criteria were identified through systematic searches of five databases, including PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Meta-analyses were conducted using Review Manager software with a random-effects model to calculate pooled relative risks (RR) and 95% confidence intervals (CI). The potential publication bias was evaluated qualitatively, and the certainty of the evidence was subsequently assessed.ResultsIn total, 10 RCTs involving 1,630 patients were included in the analysis. The results demonstrated that, compared with the BQT group, the H. pylori eradication rate was significantly higher in the probiotics combined with the BQT group (RR 1.06, 95% CI 1.01-1.11, p = 0.009, ARR = 7.5%, NNT ≈ 13). Additionally, the combined therapy significantly reduced the adverse event rate (RR 0.58, 95% CI 0.42-0.80, p = 0.001, ARR = 11.1%, NNT ≈ 9), diarrhea (RR 0.48, 95% CI 0.32-0.73, p = 0.0007, ARR = 0.7%, NNT ≈ 142), and constipation (RR 0.53, 95% CI 0.29-0.94, p = 0.04, ARR = 2.5%, NNT ≈ 40). However, no statistically significant differences were observed for other specific adverse events, including nausea, vomiting, anorexia, heartburn, belching, taste disturbance, abdominal pain, and abdominal bloating. Sensitivity analyses confirmed the robustness of the results for the H. pylori eradication rate and adverse event rate.ConclusionCombining probiotics with BQT significantly increases the H. pylori eradication rate and reduces adverse events, particularly diarrhea and constipation. These findings support the role of probiotics as a supplementary strategy to enhance both the efficacy and safety of H. pylori eradication therapy. However, the overall certainty of the evidence is low to very low, and the optimal probiotic protocol has yet to be determined, highlighting the need for further high-quality research.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251060806, Identifier CRD420251060806.

Abstract licence: CC BY

BackgroundAlthough 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.MethodsThis 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.ResultsSeventy-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.ConclusionsOur 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 registrationThai Clinical Trials Registry Identifier TCTR20250904004.

Abstract licence: CC BY-NC-ND

BackgroundTo achieve eradication rates > 90%, the ESPGHAN/NASPGHAN guidelines for pediatric Helicobacter pylori infection recommend tailored antimicrobial therapy using sufficiently high doses over 10-14 days. However, prolonged treatment often leads to suboptimal compliance in children, which is a major contributor to reduced eradication rates. To address this, we evaluated the efficacy and safety of a shorter, 7 day triple therapy with bismuth compared with the 14 day standard triple therapy without bismuth in H. pylori infected children.Materials and methodsFrom 2020 to 2024, we carried out a randomized controlled trial involving treatment-naïve children and adolescents (5-18 years old) with confirmed H. pylori infection. Eligible participants were randomly allocated to receive either a 7 day triple therapy with bismuth (bismuth subcitrate, a proton pump inhibitor [PPI], amoxicillin, plus clarithromycin/metronidazole) or a 14 day standard triple therapy (a PPI, amoxicillin, plus clarithromycin/metronidazole) without bismuth. Two months after completing therapy, treatment success was determined using either a two-step monoclonal stool antigen assay or a urea breath test. Any adverse events were documented using a structured questionnaire.ResultsSeventy-three children were enrolled in the study. In the intention-to-treat analysis, eradication was achieved in 91% of children treated with the 7 day triple therapy with bismuth and 87% of those receiving the 14 day standard triple therapy (p = 0.695). Per-protocol eradication rates were 94% and 87%, respectively (p = 0.418). No serious adverse events were reported, and most adverse events were mild to moderate. A metallic taste was significantly more frequent in the 14 day standard triple therapy group, while other adverse events occurred with similar frequency.ConclusionsAdding bismuth to a 7 day triple regimen achieved high eradication rates and a safety profile similar to 14 day standard triple therapy, supporting its use as an effective and safe treatment option for pediatric H. pylori infection.

Abstract licence: CC BY