The efficacy of bismuth subsalicylate in the treatment of acute diarrhoea and the prevention of persistent diarrhoea

A controlled, randomized, double-blind study in Bangladeshi children (ages 4-36 mo) with acute diarrhoea was undertaken to determine whether bismuth s ubsalicylate (BSS) would prevent the development of persistent diarrhoea (P D) in young children. The children were randomized to two groups: 226 were given liquid oral BSS, las Pepto-Bismol), 100 mg/kg/d for 5 d; 225 were giv en placebo of identical appearance. On admission to the study, the two grou ps were comparable both clinically and microbiologically. Rotavirus was fou nd in 56% of all the children, and enterotoxigenic E. coli in 31% of a subs ample studied. Children treated with BSS had less severe and less prolonged illness than those treated with placebo (p = 0.057). There was, however, n o difference in the development of PD between the two groups (8% and 11%). Unexpectedly, patients treated with BSS gained significantly more weight (2 .3%) than those treated with placebo (0.5% : p < 0.001) during the course o f the study. No toxicity of BSS was detected. Conclusion: Treatment with BSS had a modest therapeutic effect on acute dia rrhoea, as has been previously demonstrated, but with no suggestion of a th erapeutic effect on the prevention of persistent diarrhoea in this group of patients.