New Guidelines Prevention of Travelers Diarrhea

Something to discuss with your Healthcare Provider on Medscape today, an update of guidelines by the International Society of Travel Medicine includes the following:

• Bismuth subsalicylate (BSS) may be considered for any traveler to prevent travelers' diarrhea (strong recommendation, high level of evidence). BSS has been studied using four divided doses of either 2.1 g/day or 4.2 g/day (with meals and at bedtime). A lower divided dose of 1.05 g/day has also been shown to be preventive, although it is unclear whether it is as effective as the higher doses.
   
   
  Full guidelines here:
  https://getawaysfrom21044.wordpress.com/
  

Thank you for the information.

Sorry, that link took me to rafinmed’s blog, his solo cabin challenge. Was the link incorrect or am I missing something. I read his blog and don’t remember anything mention of BSS.

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Problem is you are not supposed to take it for more then two days:

https://reference.medscape.com/drug/kaopectate-pepto-bismol-bismuth-subsalicylate-342037

Thank you!

Not long ago a friend of ours was on assignment in India. Over the several months, his North American co-workers all ended up with "Delhi belly" at one time or another, while he remained symptom free. He attributed it to the fact that every day he chewed 1 Pepto Bismol tablet and swears if he returns, he will do so again. I know this is anecdotal, but if it works, go for it!

Smooth Sailing! :) :) :)

Sorry, that link took me to rafinmed’s blog, his solo cabin challenge. Was the link incorrect or am I missing something. I read his blog and don’t remember anything mention of BSS.

 

 

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Same here

Problem is you are not supposed to take it for more then two days:

 

https://reference.medscape.com/drug/kaopectate-pepto-bismol-bismuth-subsalicylate-342037

I saw this on the link you posted:

Traveler's Diarrhea

Prophylaxis

2 tablets (262 mg/tab) q6hr for up to 3 weeks

I may consider this on my Alaska cruise as long as I can take the caplets. The liquid and the chewables make me throw up.

Sorry, that link took me to rafinmed’s blog, his solo cabin challenge. Was the link incorrect or am I missing something. I read his blog and don’t remember anything mention of BSS.

 

 

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I'm as mystified by the link as you are.

Roy

Not long ago a friend of ours was on assignment in India. Over the several months, his North American co-workers all ended up with "Delhi belly" at one time or another, while he remained symptom free. He attributed it to the fact that every day he chewed 1 Pepto Bismol tablet and swears if he returns, he will do so again. I know this is anecdotal, but if it works, go for it!

 

Smooth Sailing! :) :) :)

Seems an easy and safe ( for most of us) good method to try. check with our doc

tors and we may all come back blessing you to the heavens. :) Those who just had their cruise on Independence of the Seas ruined by Noro would have paid a king's ransom for this preventative.

Thank you for sharing with us.

We did an overland to Agra, Jaipur, New Delhi. A Gentleman we traveled with came down with India Gut. He was on IV fluids, lost lots of weight, confined to his cabin for 30 days. My wife and I did not get sick. We didn't take anything.

I'm as mystified by the link as you are.

 

Roy

Count me in on the confused too. The link I posted from Medscape was really long, too.

I saw this on the link you posted:

 

Traveler's Diarrhea

 

Prophylaxis

2 tablets (262 mg/tab) q6hr for up to 3 weeks

 

 

I may consider this on my Alaska cruise as long as I can take the caplets. The liquid and the chewables make me throw up.

Bismuth is effective against some bacteria. I’ve been aware of it providing some protection against some sub types of shigella. There have been several studies that show prevention, (off label use) but I was surprised to see it actually come out in evidence based guidelines.

Q6hr means “every 6 hours”.

New??? When I was camping on the Sinai Desert in the mid 1980s the recommendation was to chew (or take) Bismuth tablets several times a day for the time on the Desert. PLUS, it was recommended for any travel in places where the food was a potential issue. Doing a lot of travel to what historically were called "third world countries" that has been my regimen. Only problems have been tounge surface turning dark as do some things leaving your body. I do not recall ever using it for more than a few weeks at a time - but unsure of that. Apparently for me at least it really worked - no significant GI problems in all my travels. (Keeping in mind it will not impact viral illnesses, including Noro.) Caveat - I do not eat true "street food" in many places - seems like a larger risk than I want to take when spending money to travel.

Tiogacruiser - I personally would not worry about Bismuth in Alaska. It really is quite a civilized place in terms of food, despite the impression some TV tales might show, unless you take it in your own hometown and Lower 48 cities. Sure you can acquire ills eating anywhere - but Alaska it truly equivalent to the lower 48 unless you are into hunting and eating things such as Bear, but the same applies to wild Venison someone "Killed", dressed and ate in New York, Montana, etc.

New??? When I was camping on the Sinai Desert in the mid 1980s the recommendation was to chew (or take) Bismuth tablets several times a day for the time on the Desert. PLUS, it was recommended for any travel in places where the food was a potential issue.

Same here -- my travel doc recommended this as long as 14 years ago on my first trip to Egypt.

Same here -- my travel doc recommended this as long as 14 years ago on my first trip to Egypt.

Did it, does it work for you?

Did it, does it work for you?

Although I have taken the chewable version with me on some trips (e.g., Egypt, Tunisia) as a potential preventative, I've not used them. My idea -- possibly wrong-headed -- was that I'd wait until I felt any little upset or twinge before I'd start them. So far that hasn't happened.

Appreciate the information.

Keith

Although I have taken the chewable version with me on some trips (e.g., Egypt, Tunisia) as a potential preventative, I've not used them. My idea -- possibly wrong-headed -- was that I'd wait until I felt any little upset or twinge before I'd start them. So far that hasn't happened.

The key word here is "prevention" - once you've got the upset feeling, you're past preventing it, now you're into the treatment stage. The only thing you can hope is it runs it's course (sorry, no pun intended) quickly!

Smooth Sailing! :) :) :)

The key word here is "prevention" - once you've got the upset feeling, you're past preventing it, now you're into the treatment stage. The only thing you can hope is it runs it's course (sorry, no pun intended) quickly!

Smooth Sailing! :) :) :)

I know. But given my history of not having any stomach issues when traveling, I would be a poor candidate to take it proactively. ;)

Problem is you are not supposed to take it for more then two days:

 

https://reference.medscape.com/drug/kaopectate-pepto-bismol-bismuth-subsalicylate-342037

That could be a problem.

I've never heard of the 2 days before - 2 weeks has been my experience.

Like some other meds used as a preventative - once the symptoms start it is too late to use as a preventative measure, which is the purpose of use as a prophylaxis. Otherwise it is NOT being used as a Prophylaxis, but treatment as others have mentioned. While it may help shorten the course of the symptoms, they are still there.

Does it work? Well, that is hard to say, but what I can say, after using it as a Prophylaxis for well over 100 days totally, for travel in less developed countries - I have NEVER had significant GI problems. Does the Bismuth get the credit - hard to tell as I may not have had any problems without it. I only know that some of the folks I have traveled with did get serious problems, I did not. Of course, as soon as I say this perhaps my "luck" will change, but I will still take Pepto pills to use at times on future cruises in some ports where I may be eating or drinking beverages which include local water.

Washing hands properly is cheaper, faster and is better than ''snake oil''

Sandra

Washing hands properly is cheaper, faster and is better than ''snake oil''

Sandra

Not sure I'd call a recommendation from the International Society of Travel Medicine "snake oil". :confused: And washing hands won't help if you've eaten tainted food or water.

My goodness, all this just about Pepto Bismol. This product has been a travelers friend for decades. But taking it on a routine basis for prevention does have its drawbacks so consider this info on possible side-effects:

Applies to bismuth subsalicylate: oral suspension, oral tablet, oral tablet chewable

Along with its needed effects, bismuth subsalicylate may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking bismuth subsalicylate:

In some patients bismuth subsalicylate may cause dark tongue and/or grayish black stools. This is only temporary and will go away when you Stop taking bismuth subsalicylate.

• Anxiety
  
• any loss of hearing
  
• confusion
  
• constipation (severe)
  
• diarrhea (severe or continuing)
  
• difficulty in speaking or slurred speech
  
• dizziness or lightheadedness
  
• drowsiness (severe)
  
• fast or deep breathing
  
• headache (severe or continuing)
  
• increased sweating
  
• increased thirst
  
• mental depression
  
• muscle spasms (especially of face, neck, and back)
  
• muscle weakness
  
• nausea or vomiting (severe or continuing)
  
• ringing or buzzing in ears (continuing)
  
• stomach pain (severe or continuing)
  
• trembling
  
• uncontrollable flapping movements of the hands (especially in elderly patients) or other uncontrolled body movements
  
• vision problems
  

When I worked as a Paramedic back in the 70s and early 80s I actually had two cases (one while working in the ER and the other out in the field) of Pepto Bismol related problems. Neither was particularly serious, but one did result in calling an ambulance and the other person was carried into the ER. Go figure.

Hank