J Travel Med

No relief abroad: Bismuth subsalicylate shows no significant benefit in travelers’ diarrhea

June 10, 2025

Study details: A large, double-blind, placebo-controlled randomized trial (NCT03535272) evaluated bismuth subsalicylate (BSS) 2.1 g/day (4 tablets twice daily) vs. placebo for the prevention of travelers’ diarrhea (TD) in 270 adult travelers to high-risk regions (Southeast Asia, South Central Asia, North Africa, Sub-Saharan Africa) over trips of 7 to 21 days. Participants completed web-based symptom questionnaires before, during, and after travel.

Results: There was no significant difference in the incidence of loose stool and/or diarrhea between the BSS and placebo groups. Notably, the trial didn't reach its target sample size, limiting its statistical power.

Clinical impact: These results suggest that BSS, at the studied dose and regimen, may not be effective for TD prophylaxis in contemporary travelers. Further research is needed to clarify the role of BSS prophylaxis, particularly in specific traveler subgroups or settings.

Source:

Angelo KM, et al. (2025, May 29). J Travel Med. Efficacy of Bismuth Subsalicylate on the Prevention of Travellers' Diarrhoea, 2018-2023. https://pubmed.ncbi.nlm.nih.gov/40439228/