- Study limitations:
- 8 of the pts. in the placebo group had levels of bismuth present
at the onset of the study
- subjects were all males
- anti-microbial pathogens may differ in United States (study
performed in Peru)
- Insufficient data exists as to the risk of Reye syndrome associated
with subsalicylate exposure.3
- Compliance would most likely be poor with a q4h home regimen.4
- Given the limited amount of money available in most developing nations,
funds could be better spent on other areas of health care that may be
more beneficial to children than shortening the duration of their diarrhea
(e.g. money could be spent on oral rehydration solution, IVF, etc.).
If all 1.5 billion episodes of diarrhea in young children in the developing
world were treated, it would cost about $5 billion annually, much more
than some developing nations’ entire heathcare budget.5
- Figueroa-Quintanilla D, Salazar-Lindo E, Sack RB, et al. A controlled
trial of bismuth subsalicylate in infants with acute watery diarrheal
disease. New England Journal of Medicine, 1993; 328:1653-1658.
- Soriano-Brucher H, Avendano P, O’Ryan M, et al. Bismuth subsalicylate
in the treatment of acute diarrhea in children: a clinical study.
Pediatrics, 1991; 87:18-27.
- American Academyy of Pediatrics, Subcommittee on Acute Gastroenteritis.
Practice parameter: the management of acute gastroenteritis in
young children. Pediatrics, 1996; 97:424-435.
- Cockburn J, Gibberd RW, Reid AL, Sanson-Fisher RW. Determinants of
non-compliance with short term antibiotic regimens. BMJ, 1987;
- Snyder JD. Can bismuth improve the simple solution for diarrhea?
New England Journal of Medicine, 1993; 328:1705-1706.