Journal of Clinical Toxicology
Open Access

Abstract

Medical Use of Bismuth: the Two Sides of the Coin

Frank Thomas, Beatrix Bialek and Reinhard Hensel

Inorganic bismuth derivatives have good antibacterial properties and are considered to be only slightly toxic to humans because of their low uptake into human cells. Compounds containing bismuth are therefore widely used in medical applications. Bismuth-containing pharmaceuticals, partially in synergy with antibiotics, are already used or are being considered in the treatment of infections caused by certain bacteria, especially to eradicate Helicobacter pylori, Pseudomonas aeruginosa, Burkholderia multivorans and B. cenocepacia. However, careless use of bismuth containing pharmaceuticals can result in encephalopathy, renal failure and other adverse effects. Microbial methylation of bismuth by the human gut microbiota has recently been reported. As the lipophilicity and thus the membrane permeability of bismuth are increased by these methylation processes, the toxic effects on human cells and on members of the beneficial “physiological” gut microbiota must be considered in medical application of bismuth-containing drugs.