Bismuth is a naturally occurring mineral that can act as an antacid as well as against H. pylori. Bismuth preparations are now often prescribed along with triple therapy as a component in quadruple therapy for the eradication of H. pylori. The best-known and most widely used bismuth preparation is bismuth subsalicylate (Pepto-Bismol). However, bismuth subcitrate has produced the best results against H. pylori and in the treatment of non-ulcer-related indigestion as well as peptic ulcers. In the United States, bismuth subcitrate preparations are available by prescription through compounding pharmacies (contact the International Academy of Compounding Pharmacists,
One of the main advantages of bismuth preparations over standard antibiotic approaches to eradicating H. pylori is that whereas the bacteria may develop resistance to various antibiotics, they are very unlikely to develop resistance to bismuth.
The usual dosage for bismuth subcitrate is 240 milligrams (mg) twice daily before meals. For bismuth subsalycilate the dosage is 500 mg - two tablets or 30 milliliters (mL) of standard-strength Pepto-Bismol - four times daily.
Bismuth preparations are extremely safe when taken at prescribed dosages and for less than six weeks at a time. Bismuth subcitrate may cause a temporary and harmless darkening of the tongue, the stool, or both. Bismuth subsalicylate should not be taken by children recovering from the flu, chicken pox, or some other viral infections, as it may mask the nausea and vomiting associated with Reye's syndrome, a rare but serious illness.