Sir.—The recent review article by Lindsley1 suggests the use of various antacids, including bismuth subsalicylate (Pepto-Bismol and others), to minimize salicylate-induced gastric irritation. The salicylate in bismuth subsalicylate is almost completely bioavailable2; 15 mL of Pepto-Bismol liquid contains 130mg of salicylate. The recommended dosage for a 9-year-old child is 15 mL for up to eight times per 24 hours.3 Added to an anti-inflammatory dosage regimen of aspirin, this can be enough to produce serious intoxication.
LEVY G. Aspirin and Bismuth Subsalicylate. Am J Dis Child. 1993;147(12):1281. doi:10.1001/archpedi.1993.02160360023010