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Common Medicines That Disrupt the Normal Gut Microbiome

Research has found that antibiotics disrupt a person's normal gut microbiome (microbial community), especially because the antibiotics kill both bad (pathogenic) and beneficial bacteria. But what about other medicines? Do they also have an effect?

A recently published study that reviewed the research looked precisely at that topic and found that YES - other medicines (besides antibiotics) also have an effect on (disrupt) the gut microbiome. The different categories of drugs - proton pump inhibitors (PPIs), metformin, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, statins and antipsychotics - all had different kinds of impacts on the gut microbiome.

The researchers also suggest that other types of commonly prescribed medicines now need to be examined for their impact on the intestinal (gut) microbiome, such as thyroid hormones, contraceptive drugs, and antihypertensive (high blood pressure) drugs. Excerpts from Dr. Paul Enck's article about the study at Gut Microbiota Research and Practice:

A systematic review explores the role of non-antibiotic prescription drugs in gut microbiota dysbiosis

Both diet and medications are among the strongest variables affecting the gut microbiome. When it comes to medications, although antibiotics have been repeatedly shown to affect the human gut microbiome, little is known regarding the impact of non-antibiotic prescription drugs on the gut microbiome.

review, led by Dr. Emmanuel Montassier from the MiHAR Lab at Institut de Recherche en Santé 2, Université de Nantes (Nantes, France), has concluded that some non-antibiotic prescription drugs have a notable impact on the gut microbiome to the same extent as antibiotics

The researchers conducted a systematic review for assessing the impact of the most frequently non-antibiotic prescribed therapeutic drug categories - proton pump inhibitors (PPIs), metformin, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, statins and antipsychotics - on the gut microbiome. Studies that included preclinical models and those that studied the gastric microbiota or were based on culture-dependent techniques were ruled out ..... 20 studies were included in the systematic review.

PPIs and antipsychotic medications were associated with a decrease in a diversity - the average species diversity within an individual site - in the gut microbiome, whereas opioids were associated with an increase in a diversity. On the other hand, metformin and NSAIDs were not associated with significant changes in a diversity. Besides this, all prescribed therapeutic drugs except NSAIDs led to a significant alteration of b diversity - that is, the intervariability or diversity between different samples.

Specifically, the review reported taxonomic changes induced by medications. PPI use was related to a decrease in Clostridiales and an increase in Actinomycetales, Micrococcaceae and Streptococcaceae, which are changes that have previously been involved in gut dysbiosis and increased susceptibility to Clostridium difficile infection. Noticeably, microbial families that were abundant in the guts of PPI users were more often found in the mouth/throat, skin/nose or vaginal sites of healthy individuals rather than in their guts. PPIs, metformin, NSAIDs, opioids and antipsychotics were associated with increases in either members of class Gammaproteobacteria (including Enterobacter, Escherichia, Klebsiella, Citrobacter, Salmonella and Proteus) or members of family Enterococcaceae. All of them are frequently isolated pathogens from blood culture samples of patients with sepsis, especially critically ill and cancer patients.

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