Have a patient with acute diarrhea? Are they looking for some simple and affordable relief? Then consider good old fashion bismuth subsalicylate (Pepto-Bismol)! Yes, this works remarkably well for treating acute episodes of diarrhea, yet many of us forget it even exists. Plus, its CHEAP!

I have used bismuth in my practice for almost a decade. I learned this trick in the emergency department from an old school ER physician who swore on using bismuth for the treatment of acute diarrhea. Additionally, it can be used in patients with fever and inflammatory diarrhea safely.

Pepto-Bismol works by creating bismuth salts within the GI tract that contain bactericidal and antimicrobial properties. This prevents the invading organism from binding to the mucosal cells of the GI tract. Additionally, this mechanism prevents intestinal secretion, it promotes fluid absorption, and reduces inflammation!

Dosing is simple: have the patient take 2 tablets (262mg each) or 30ml of the liquid formulation every 30-60 minutes until the diarrhea resolves. You do not want the patient to take more than 8 doses within a 24-hour period, but I have seen up to 10 doses used safely. If the diarrhea persists for more than 2-3 days, then further workup should be initiated to determine the cause vs treating symptoms. More times than not though, this simple remedy works, and the patient can go about their day, diarrhea free!