Le Bastard Q, et al. - Here, the physicians systematically reviewed studies reporting non-antibiotic prescription drug-induced human gut microbiome changes, focusing on the most frequently prescribed therapeutic drug categories from the aforementioned national ambulatory medical care survey. A notable impact on the overall architecture of the intestinal microbiome was observed due to non-antibiotic prescription drugs. They recommended further explorations to define biomarkers of dysbiosis induced by specific drugs, and potentially tailor live biotherapeutics to counter this drug-induced dysbiosis.

Methods

• A systematic review was conducted by first searching in online databases for indexed articles and abstracts in accordance with PRISMA guidelines.
• The physicians included studies evaluating the intestinal microbiome alterations associated with proton pump inhibitors (PPIs), metformin, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, statins, and antipsychotics.
• Only the studies using culture-independent molecular techniques were included.

Results

• While opioids were correlated with an increase in α diversity, PPIs and antipsychotic medications were associated with a decrease in α diversity in the gut microbiome.
• In α diversity, metformin and NSAIDs were not correlated with significant changes.
• Except for NSAIDs, β diversity was found to be significantly altered with all drugs.
• PPI use was linked to a decrease in Clotridiales and increase in Actinomycetales, Micrococcaceae, and Streptococcaceae, these were previously implicated in dysbiosis and increased susceptibility to Clostridium difficile infection.
• As per findings, 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 were frequently isolated from bloodstream infections in critically ill patients.
• Furthermore, the physicians found that antipsychotic treatment was marked by a decreased ratio of Bacteroidetes, which was usually associated with an increase in body mass index: Firmicutes in the gut microbiome, resembling trends seen in obese patients.