{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:23:23Z","timestamp":1791339803619,"version":"4.3.1"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"6","funder":[{"name":"Cooperative Research and Development Agreement","award":["D-129-18-00"],"award-info":[{"award-number":["D-129-18-00"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Travellers\u2019 diarrhoea (TD) is the most common travel-related illness. Bismuth subsalicylate (BSS) is indicated for the treatment of TD. BSS is also used off-label for the prevention of TD, based on studies from the 1980s indicating TD protection; however, these studies have limitations. The objective of this study was to determine the efficacy of BSS in the prevention of TD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study was a prospective, double-blinded, placebo-controlled, randomized clinical trial (NCT03535272) with two arms: BSS 4 tablets twice daily (2.1 grams of BSS total) vs placebo. Travellers were included if they were\u2009\u2265\u200918 and\u2009&amp;lt;\u200970\u00a0years of age at the time of enrollment, were leaving for an international trip \u22657\u00a0days after their pretravel consultation, travelling in country for \u22657\u00a0days but \u2264\u200921\u00a0days, and travelling to either Southeast Asia, South Central Asia, North Africa, or Sub-Saharan Africa. Self-completed web-based questionnaires were administered before, during, and after travel.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>270 participants were included. The median age was 32\u00a0years (Interquartile range [IQR]: 27\u201344); 63% were female. Travellers were most frequently White (144; 61%) and non-Hispanic (239; 94%). The most frequent country of travel was Kenya (n\u2009=\u200987; 32%). The median total trip duration was 10\u00a0days ([IQR]: 8\u201313). The most frequent reason for travel was leisure\/tourism (230, 85%). There was no significant difference among the groups for symptoms of loose stool and\/or diarrhoea, although target sample size was not reached.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study provides the first new data since the 1980s about the potential use of BSS in the prevention of TD. These data should not be viewed as evidence in isolation because of sample size constraints; further studies are needed to determine if there is a benefit in certain traveller groups or under certain circumstances.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jtm\/taaf047","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T08:21:39Z","timestamp":1748506899000},"source":"Crossref","is-referenced-by-count":7,"title":["Efficacy of bismuth subsalicylate on the prevention of travellers\u2032 diarrhoea, 2018\u20132023"],"prefix":"10.1093","volume":"32","author":[{"given":"Kristina M","family":"Angelo","sequence":"first","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5577-0756","authenticated-orcid":false,"given":"Zainab","family":"Salah","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Rogova","sequence":"additional","affiliation":[{"name":"New York Center for Travel and Tropical Medicine , 110 E 55th St, New York, NY 10022,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4747-381X","authenticated-orcid":false,"given":"Ian D","family":"Plumb","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison T","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme","family":"Prentice-Mott","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charandeep","family":"Waraich","sequence":"additional","affiliation":[{"name":"New York Center for Travel and Tropical Medicine , 110 E 55th St, New York, NY 10022,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunkyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Ryan","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital , Division of Infectious Diseases, 55 Fruit St, Boston, MA 02114,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina C","family":"LaRocque","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital , Division of Infectious Diseases, 55 Fruit St, Boston, MA 02114,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Oliver","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital , Division of Infectious Diseases, 55 Fruit St, Boston, MA 02114,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Heitzinger","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K Allison","family":"Perry-Dow","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , 1600 Clifton Rd NE, Atlanta, GA 30329,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A","family":"Connor","sequence":"additional","affiliation":[{"name":"New York Center for Travel and Tropical Medicine , 110 E 55th St, New York, NY 10022,","place":["USA"]},{"name":"Weill Cornell Medical College , 1300 York Avenue, New York, NY 10065,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"2025100302015310400_ref1","first-page":"85","volume-title":"Yellow Book","author":"Connor","year":"2024"},{"key":"2025100302015310400_ref2","doi-asserted-by":"crossref","first-page":"taae008","DOI":"10.1093\/jtm\/taae008","article-title":"Incidence and risk factors for travellers\u2019 diarrhoea among short-term international adult travellers from high-income countries: a systematic review with meta-analysis of cohort studies","volume":"32","author":"Carroll","year":"2024","journal-title":"J Travel Med"},{"key":"2025100302015310400_ref3","first-page":"0901","article-title":"Travellers\u2019 diarrhoea","author":"Heather","year":"2015","journal-title":"BMJ Clin Evid"},{"key":"2025100302015310400_ref4","article-title":"Prevention and treatment of Traveler\u2019s Diarrhea","volume-title":"Am Fam Physician","author":"American Family Physician","year":"1999"},{"key":"2025100302015310400_ref5","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/S1473-3099(16)30319-X","article-title":"Import and spread of extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study","volume":"17","author":"Arcilla","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2025100302015310400_ref6","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1056\/NEJMc1912464","article-title":"Acquisition of antibiotic-resistant bacteria by U.S. international travelers","volume":"382","author":"Mellon","year":"2020","journal-title":"N Engl J Med"},{"key":"2025100302015310400_ref7","doi-asserted-by":"crossref","first-page":"S64","DOI":"10.1093\/clinids\/12.Supplement_1.S64","article-title":"Use of bismuth subsalicylate for the prevention of travelers\u2019 diarrhea","volume":"12","author":"DuPont","year":"1990","journal-title":"Rev Infect Dis"},{"key":"2025100302015310400_ref8","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1001\/jama.1987.03390100085031","article-title":"Prevention of travelers\u2019 diarrhea by tablet formulation of bismuth subsalicylate","volume":"257","author":"DuPont","year":"1987","journal-title":"JAMA"},{"key":"2025100302015310400_ref9","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1128\/AAC.29.4.625","article-title":"Prevention of travelers\u2019 diarrhea by the tablet form of bismuth subsalicylate","volume":"29","author":"Steffen","year":"1986","journal-title":"Antimicrob Agents Chemother"},{"key":"2025100302015310400_ref10","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S0016-5085(83)80066-3","article-title":"Double-blind comparison of bismuth subsalicylate and placebo in the prevention and treatment of enterotoxigenic Escherichia coli-induced diarrhea in volunteers","volume":"85","author":"Graham","year":"1983","journal-title":"Gastroenterology"},{"key":"2025100302015310400_ref11","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1007\/s10620-020-06509-7","article-title":"Systematic review and meta-analyses assessment of the clinical efficacy of bismuth subsalicylate for prevention and treatment of infectious diarrhea","volume":"66","author":"Brum","year":"2021","journal-title":"Dig Dis Sci"},{"key":"2025100302015310400_ref12","doi-asserted-by":"crossref","first-page":"2266","DOI":"10.1001\/jama.1982.03320410048030","article-title":"Influence of subsalicylate bismuth on absorption of doxycycline","volume":"247","author":"Ericsson","year":"1982","journal-title":"JAMA"},{"key":"2025100302015310400_ref13","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1080\/19490976.2015.1008336","article-title":"Antimicrobial activity of bismuth subsalicylate on Clostridium difficile, Escherichia coli O157:H7, norovirus, and other common enteric pathogens","volume":"6","author":"Pitz","year":"2015","journal-title":"Gut Microbes"},{"key":"2025100302015310400_ref14","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1093\/clinids\/12.Supplement_1.S11","article-title":"In vitro antimicrobial activity of bismuth subsalicylate and other bismuth salts","volume":"12","author":"Manhart","year":"1990","journal-title":"Rev Infect Dis"}],"container-title":["Journal of Travel Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jtm\/advance-article-pdf\/doi\/10.1093\/jtm\/taaf047\/63397676\/taaf047.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jtm\/article-pdf\/32\/6\/taaf047\/63397676\/taaf047.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jtm\/article-pdf\/32\/6\/taaf047\/63397676\/taaf047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T06:01:58Z","timestamp":1759471318000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jtm\/article\/doi\/10.1093\/jtm\/taaf047\/8152723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":14,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,5,29]]},"published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jtm\/taaf047","relation":{},"ISSN":["1195-1982","1708-8305"],"issn-type":[{"value":"1195-1982","type":"print"},{"value":"1708-8305","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,5,29]]},"article-number":"taaf047"}}