THE POWER OF PEPTO-BISMOL--Prevents Most "Traveler's Diarrhea"! (Edited April 29, 2023)

We Never Leave Home Without It!

Pepto-Bismol or the Generic Tablets Work!

    It’s common knowledge that “Traveler’s Diarrhea” can ruin a vacation. However, it seems few people take all of the steps needed to prevent it. Of course, most people are aware of the basics. Drinking purified water, not tap water, and plenty of it is the first step. Frequent hand washing with soap and water is important. Eating at reliable establishments with running water and sewer facilities is also key to staying healthy while traveling. Avoiding overexposure to the sun and minimizing alcohol ingestion are often overlooked factors in helping the body fight off intestinal infections. All standard advice…

     But how many people realize the power of taking Pepto-Bismol® or the generic equivalent, bismuth subsalicylate, to prevent and even help treat many “Traveler’s Diarrheas”? “The U.S.Centers for Disease Control and Prevention (CDC) reports that travelers can reduce the risk of intestinal woes by approximately 50 percent by taking Pepto-Bismol (either two ounces of liquid or two chewable tablets four times per day). Pepto-Bismol should not be taken for more than three weeks at a time, and anyone thinking about taking it as a preventative measure should follow the instructions and recommendations on the packaging.”

     We stock up on the generic tablets in the U.S. and bring several hundred with us each year when we return home to Sayulita. We never leave home without it—we always keep several boxes of both chewable and swallowable tablets in the motorhome and I carry some in my purse and backpack at all times, just in case! Pepto-Bismol has prevented ruined vacations for us many times.

     Even after living in México for over three years, and traveling in this country for over twenty-five years, Jon and I still occasionally eat something that causes that rumbling and grumbling in our intestines a few hours later that indicates a virus or bacteria is “trying to infect” us. We immediately take two Pepto-Bismol or bismuth subsalicylate tablets with a large glass of water. Usually one dose of two tablets takes care of the problem for us.

     For best results, we pay attention to those intestinal rumblings and start taking Pepto-Bismol right away. Waiting until the diarrhea has already started may be too late. That’s when I think, why did I wait? This could have been prevented! Now I won’t feel good enough to go out for dinner for days!

     I’ve often wondered why more people don’t know about the power of Pepto-Bismol. When I was practicing as a pharmacist and patients asked for my recommendation to prevent “Traveler’s Diarrhea”, I always recommended the course of prevention and treatment I’ve listed below. Many have thanked me for the information. It’s not for everyone, but if your doctor agrees, you may want to give this a try. *

“Traveler’s Diarrhea” Prevention*

     Pepto-Bismol® (bismuth subsalicylate) has antibacterial properties, meaning it kills some bacteria that cause diarrhea, including E. coli. It also prevents diarrhea by retarding the expulsion of fluids into the digestive system through irritated tissues by "coating" them, and it reduces inflammation and irritation of the stomach and intestinal lining.

     Jon and I have found that it is very useful to prevent “Traveler’s Diarrhea” when entering México and other countries, especially the first couple of times we visit a new country. We even have to resort to taking it for a couple of weeks when returning to the United States after living in México for nine months. It’s as though our gastrointestinal system has adapted to the microorganisms in the food in México, and the bacteria in the U.S. have become “foreign” to us.

     One of the worst cases of foodborne diarrhea I’ve ever experienced occurred on the first day back in the U.S. after traveling for six months throughout México. I hadn’t been taking Pepto-Bismol for months as my system had adjusted to food in México. I didn’t think I needed to take it since we were going to a nice restaurant for an expensive steak dinner, which was delicious. I was so sick that night. I learned my lesson. Now, after an extended time out of the United States, I start taking Pepto-Bismol the day before entering the country and continue for at least a week, according to the schedule below.

Edited April 29, 2023

If you become constipated at any time while taking Pepto Bismol, stop taking it until bowel movements return to normal. Signs of constipation may include:

• fewer than three bowel movements a week.
• stools that are hard, dry, or lumpy.
• stools that are difficult or painful to pass.
• a feeling that not all stool has passed.

Here is the Pepto-Bismol schedule that works for us:

·       Week 1 – 2, Beginning 24 hours before entry into the area of risk

     Take two Pepto-Bismol or bismuth subsalicylate 262mg tablets by mouth three or four times daily for two weeks. Increase dosage as needed according to signs and symptoms of intestinal upset from food and water, but not more than sixteen tablets daily.

(Note: the amount of salicylate at this dose has some blood-thinning properties. If you take aspirin or any medication containing aspirin, consult your physician about possibly adjusting your aspirin dose during this period. If you suffer from VWD or any other disorder associated with thin blood or anemia, consult your physician before taking bismuth subsalicylate. We decrease our 81mg aspirin dose from one tablet daily to one tablet every other day during this period.)

·       Week 3 – 4

             Take two bismuth subsalicylate 262 mg tablets by mouth twice daily. If signs of intestinal irritation from food or water begin (“gurgling” or “grumbling” sounds and feelings of intestinal “churning”, upset stomach, mild diarrhea, etc.), increase dose to two tablets three or four times daily until symptoms subside, or as needed but not more than sixteen tablets daily.

       ·       Week 5 – 6

            Take one bismuth subsalicylate 262mg tablet twice daily. Increase dosage as needed according to signs and symptoms of intestinal upset from food and water, but not more than sixteen tablets daily.

       ·       Week 7 on

            Take two bismuth subsalicylate 262mg tablets by mouth only when needed for signs and symptoms of intestinal upset from food and water, up to a maximum of two tablets eight times daily.

     “Traveler’s Diarrhea” Treatment*

      If “Traveler’s Diarrhea” occurs (severe diarrhea and cramping, sometimes accompanied by vomiting), we stop taking bismuth subsalicylate and begin taking Cipro® (ciprofloxacin) 500mg tablets by mouth twice daily for three days. We also stop taking all minerals for three days (Calcium, magnesium, iron, zinc, chromium, selenium, vitamins with minerals, antacids such as Tums® and Mylanta®, etc.) which decreases the effectiveness of ciprofloxacin. Consult a physician, especially if diarrhea does not improve within 48 hours of beginning the ciprofloxacin. Stay hydrated by drinking plenty of fluid. Gatorade® and ginger ale are beneficial.

*Before taking Pepto-Bismol or bismuth subsalicylate to prevent or treat “Traveler’s Diarrhea”, I recommend checking with your physician to be sure it is acceptable for your medical history and age. Caution in children under age 12. Some side effects may occur. Read more at https://en.wikipedia.org/wiki/Bismuth_subsalicylate 

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