Effects of non-antibiotic pharmacotherapy upon the microbiome – a role in the evolution of disease?

The gut microbiome and its relationship to health/disease is a topic of increasing interest in recent times. A recent analysis has been performed with the aim of summarising current findings on non‐antibiotic prescription‐induced gut microbiome changes, focusing on the most frequently prescribed categories of drugs. PPIs and antipsychotics are associated with a decrease in α diversity in the gut microbiome, opioids were associated with an increase in α diversity, and metformin and NSAIDs were not associated with significant changes in α diversity. PPI use was linked to changes previously increased susceptibility to Clostridium difficile infection. PPIs, metformin, NSAIDs, opioids and antipsychotics were either associated with increases in members of class Gammaproteobacteria (including Enterobacter, Escherichia, Klebsiella and Citrobacter), or members of family Enterococcaceae, which are often pathogens isolated from bloodstream infections in critically ill patients. Antipsychotics, known to be associated with an increase in body mass index, was marked by a decreased ratio of Bacteroidetes:Firmicutes in the gut microbiome, a trend observed people with obesity.The authors of the study, published here, advocate for further research addressing the effects of commonly prescribed drugs upon the microbiome, and the links between possible iatrogenic changes and the evolution of disease.