The effect of antibiotics on the composition of the intestinal microbiota - a systematic review

Zimmermann, Petra; Curtis, Nigel

doi:10.1016/j.jinf.2019.10.008

Cited by 264 publications

(247 citation statements)

References 163 publications

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“…Sulfonamide antibiotics appear to largely affect only Bacteriodetes and Firmicutes colonies in the GI tract 63 . Similar microbiome alterations associated with certain antibiotic classes were also reported in a recent systematic review 64 . A large review assessing the impact of 68 different antibiotic classes also noted a synergistic effect on commensal organisms when antibiotics were used in combination 65 .…”

Section: Antimicrobial Stewardshipsupporting

confidence: 58%

Altering Routine Intensive Care Unit Practices to Support Commensalism

Hamilton

Behal

2020

Nut in Clin Prac

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The gastrointestinal (GI) tract consists of trillions of organisms that support multiple functions in the body, from immunity, digestion, and absorption to drug metabolism. These microbes form an overall collection of microorganisms that form the body's microbiome. In critical illness, many of these functions are aberrant, and the microbiome is altered, leading to untoward effects. Some of the most common medications received by patients include antibiotics and proton pump inhibitors, which affect particular changes in the microbiome. In addition, patients receiving prolonged enteral and parenteral nutrition experience changes in the microbiological composition and diversity of their GI tracts. Research is ongoing to characterize the crosstalk between the microbiome and immune function as targets for drug and nutrition therapy.

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Section: Antimicrobial Stewardshipsupporting

confidence: 58%

Altering Routine Intensive Care Unit Practices to Support Commensalism

Hamilton

Behal

2020

Nut in Clin Prac

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“…This antibiotic prevents the formation of peptide bonds effectively inhibiting protein synthesis by binding to the 50S ribosomal subunit. Clindamycin palmitate is hydrolyzed in the gastrointestinal tract and then distributed across the body [121].…”

Section: Discussionmentioning

confidence: 99%

The pleiotropic effects of prebiotic galacto-oligosaccharides on the aging gut

Arnold

Roach

Fabela

et al. 2020

Preprint

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Background: Prebiotic galacto-oligosaccharides (GOS) have an extensively demonstrated beneficial impact on intestinal health. In this study, we determined the mechanistic impact of GOS diets on hallmarks of gut aging: microbiome dysbiosis, inflammation, and intestinal barrier defects (“leaky gut”). We also evaluated if short-term GOS feeding influenced how the aging gut responded to antibiotic challenges, since these interventions are common and relevant in older adults. Finally, we assessed the ability of colonic organoids to reproduce in vivo responses to GOS.Results: Old animals had a distinct microbiome characterized by lower diversity, increased ratios of non-saccharolytic versus saccharolytic bacteria and lower abundance of O-Glycosyl hydrolases . GOS treatment increased abundance of non-saccharolytic ( Akkermansia muciniphila ) and saccharolytic bacteria (species of Bacteroides and Lactobacillus ), and increased the abundance of β-galactosidases and β-glucosidases in young and old animals . Clyndamicin treatment reduced the abundance of beneficial bacteria including Bifidobacterium and Lactobacillus , while increasing Akkermansia, Clostridium, Coprococcus, Enterococcus, Bacillus, Bacteroides, and Paenibacillus . Prebiotics impacted the effects of the antibiotics decreasing the abundance of Akkermansia in the GOS-antibiotic groups compared to the control-antibiotics groups. GOS reduced the age-associated increased intestinal permeability via increased MUC2 expression and mucus biosynthesis. T ranscriptomics analysis of colon from old animals fed GOS diets showed increased expression of genes involved in small molecule metabolic processes and specifically the respirasome, which could indicate an increased oxidative metabolism and energetic efficiency. In young mice, GOS induced expression of binding-related genes and the galectin gene Lgals1 , a β-galactosyl-binding lectin that bridges molecules by their sugar moieties, forming a signaling and adhesion network. Further analysis showed higher expression levels of genes in focal adhesion, PI3K-Akt and ECM-receptor interaction pathways. GOS reduced the expression of TNF  in old animals, and altered serum levels of inflammatory biomarkers IL-6, IL-17, IP-10 and Eotaxin. Stools from young mice exhibiting variable bifidogenic response to GOS, injected into colon organoids in the presence of prebiotics, reproduced the response and non-response phenotypes.Conclusions: GOS modulation of intestinal homeostasis likely occurs through direct GOS-host interactions via modulation of host gene expression and mucus production, as well as through interactions mediated by the gut microbiota that result in increased or restored saccharolytic potential.

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“…Other reviews have also reported and summarised how antibiotics change the abundance and diversity of the intestinal microbiota. [68][69][70] Here, we focus on those antibiotics routinely prescribed by general practitioners (GPs) in primary care. Often GPs inappropriately prescribe antibiotics for infections caused by viruses, or prescribe a broad-spectrum antibiotic, when an antibiotic for a specific bacteria should be used.…”

Section: Comparative Observationsmentioning

confidence: 99%

Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review

et al. 2020

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ObjectiveThe gut microbiota influences many aspects of human health. We investigated the magnitude and duration of changes in gut microbiota in response to antibiotics commonly prescribed in UK primary care.MethodsWe searched MEDLINE, EMBASE and AMED, all years up to May 2020 including all study designs, collecting and analysing data on the effect of antibiotics prescribed for respiratory and urinary tract infections. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane standard methods. Risk of bias was evaluated using the Critical Appraisal Skills Programme. Narrative synthesis was used to report the themes emerging from the data.Main outcome measuresPrimary outcomes were antibiotic-induced changes in the composition and/or diversity of the gut microbiota. Secondary outcome was the time for the microbiota to return to baseline.ResultsThirty-one articles with low or unclear risk of bias showed that antibiotics impact the gut microbiota by causing rapid and diminished levels of bacterial diversity and changes in relative abundances. After cessation of treatment, gut bacteria recover, in most individuals, to their baseline state within a few weeks. Some studies suggested longer term effects from 2 to 6 months. Considerable heterogeneity in methodology makes the studies prone to biases and other confounding factors. Doxycycline was associated with a marked short-term decrease in Bifidobacterium diversity. Clarithromycin decreased the populations of Enterobacteria, and the anaerobic bacteria Bifidobacterium sp and Lactobacillus sp in numbers and diversity for up to 5 weeks. Phenoxymethylpenicillin, nitrofurantoin and amoxicillin had very little effect on the gut microbiome.ConclusionsDespite substantial heterogeneity of the studies and small sample sizes, there is evidence that antibiotics commonly used in primary care influence the composition of the gastrointestinal microbiota. Larger population-based studies are needed to fully understand how antibiotics modulate the microbiota, and to determine if these are associated with (longer term) health consequences.PROSPERO registration numberCRD42017073750.

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The effect of antibiotics on the composition of the intestinal microbiota - a systematic review

Cited by 264 publications

References 163 publications

Altering Routine Intensive Care Unit Practices to Support Commensalism

Altering Routine Intensive Care Unit Practices to Support Commensalism

The pleiotropic effects of prebiotic galacto-oligosaccharides on the aging gut

Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review

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