Bismuth drugs as antimicrobial agents

Bismuth-based agents have been widely used in medicine, particularly as the active components for the treatment of Helicobacter pylori-associated gastrointestinal ailments. The selective toxicity of bismuth toward Helicobacter pylori stems from the intrinsic chemical and biological properties of bismuth. The molecular targets of bismuth agents and their antimicrobial mechanisms of action are reviewed. Beyond anti-Helicobacter pylori actions, novel bismuth-based agents with broad antimicrobial activities against both Gram-positive and Gram-negative bacterial pathogens are highlighted. Intriguingly, bismuth-based combination therapy could effectively treat infections caused by antibiotic resistant superbugs. This chapter strives to offer an account of state-of-the-art research progress on antibacterial mechanisms of action of bismuth and explore the frontiers of up-to-date potential medicinal applications of bismuth-based agents with reference to recent developments in the literature.