Antimicrobial activity of bismuth subsalicylate on Clostridium difficile, Escherichia coli O157:H7, norovirus, and other common enteric pathogens

Gut Microbes. 2015;6(2):93-100. doi: 10.1080/19490976.2015.1008336.


Previous studies have shown bismuth subsalicylate (BSS) has antimicrobial properties, but few studies have addressed the mechanism of action. Furthermore, following BSS ingestion other bismuth salts form throughout the gastrointestinal tract including bismuth oxychloride (BiOCl) that also act upon enteric pathogens. To further understand the antimicrobial activity of bismuth in infectious diarrhea, the antimicrobial effect of BSS and BiOCl on Clostridium difficile, Salmonella, Shigella, Shiga toxin-producing Escherichia coli strains and norovirus (NoV) were measured. Bacterial enteric pathogens in pure culture or in human fecal material were exposed to 35mg/ml BSS or BiOCl with or without a vehicle suspension. BSS and BiOCl treated samples were quantified and visualized by transmission electron microscopy. To measure the effect on NoV, reduction of infectious murine NoV (MNV), a surrogate for human NoV, and Norwalk virus RNA levels were measured by viral plaque assay and RT-qPCR, respectively. BSS and BiOCl reduced bacterial growth by 3-9 logs in all strains with majority resulting in populations of <10 cfu/ml within 24 h. Similar results were found when fecal material was included. Microscopy images detected bismuth on bacterial membranes and within the bacterial organisms at 30 min post-treatment. At 8.8mg/ml BSS and BiOCl reduced infectivity of MNV significantly by 2.7 and 2.0 log after 24 h of exposure. In addition, both BSS and BiOCl slightly reduced the level of Norwalk replicon-bearing cells suggesting that bismuth may inhibit NoV in vivo. Collectively, our results confirm and build on existing data that BSS has antimicrobial properties against a wide-range of diarrhea-causing pathogens.

Keywords: BSS, bismuth subsalicylate; BiOCl, bismuth oxychloride; Clostridium difficile; ETEC, enterotoxigenic Eschericia coli; Escherichia coli; GI, gastrointestinal; MIC, minimum inhibitory concentration; MNV, murine norovirus; NoV, norovirus; SS, sodium salicylate; Salmonella; Shigella; TD, traveler's diarrhea; TEM, transmission electron microscopy; bismuth oxychloride; bismuth subsalicylate; diarrhea; enteric pathogens; norovirus.

MeSH terms

  • Animals
  • Anti-Infective Agents / pharmacology*
  • Bacterial Load
  • Bismuth / pharmacology*
  • Clostridioides difficile / drug effects*
  • Enterobacteriaceae / drug effects*
  • Humans
  • Mice
  • Microbial Sensitivity Tests
  • Microbial Viability / drug effects
  • Microscopy, Electron, Transmission
  • Norovirus / drug effects*
  • Organometallic Compounds / pharmacology*
  • RNA, Viral / analysis
  • Real-Time Polymerase Chain Reaction
  • Reverse Transcriptase Polymerase Chain Reaction
  • Salicylates / pharmacology*
  • Viral Load
  • Viral Plaque Assay


  • Anti-Infective Agents
  • Organometallic Compounds
  • RNA, Viral
  • Salicylates
  • bismuth oxychloride
  • bismuth subsalicylate
  • Bismuth