Prevention of travelers' diarrhea by nonantibiotic drugs

Travelers have resorted to a variety of drugs for prevention of diarrhea. No beneficial prophylactic effect has been confirmed for halogenated hydroxyquinoline, lactobacilli, antimotility drugs, ethacridine, and various other agents. In contrast, bismuth subsalicylate (BSS) in liquid form reduced the incidence of diarrhea in students from the United States living in Mexico and in tablet form in volunteers challenged by enterotoxigenic Escherichia coli. In tourists visiting various developing countries, a randomized, double-blind study was conducted in which 390 persons received a total of 2.1 or 1.05 g of BSS daily or placebo in tablet form in two doses. BSS reduced the incidence of diarrhea by 41% in the high-dose group and by 35% in the low-dose group without causing important adverse reactions.