Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Bismuth compounds, most notably bismuth subsalicylate and bismuth subcitrate, have established scientific use in the treatment of certain bacterial infections, particularly in the gastrointestinal tract. Their most well-documented application is as part of quadruple therapy for Helicobacter pylori infection, which is a common cause of peptic ulcers. In these regimens, bismuth compounds are combined with antibiotics and a proton pump inhibitor. Clinical trials and meta-analyses have demonstrated that bismuth-containing regimens are effective in eradicating H. pylori, especially in cases where first-line therapies have failed or antibiotic resistance is present. Bismuth compounds act by disrupting bacterial cell walls, inhibiting bacterial enzymes, and preventing bacterial adherence to gastric mucosa. There is less robust evidence for bismuth’s antibacterial efficacy outside of the gastrointestinal tract, and bismuth is not widely used for other types of bacterial infections. While its use in traditional medicine predates modern clinical studies, the contemporary application is strongly supported by clinical evidence, particularly for gastric infections. The overall evidence rating is high (4/5) due to multiple randomized controlled trials and guideline recommendations supporting its use as part of combination therapy for H. pylori infection.

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