Reflexo da farmacoterapia na microbiota intestinal

Abstract

The gut microbiota is a complex and dynamic ecosystem essential for metabolic, immunological, and neuroendocrine homeostasis. Advances in molecular techniques and metagenomic analysis have revealed that drug-induced alterations—caused not only by antibiotics but also by non-antibiotic medications such as proton pump inhibitors (PPIs), metformin, and antipsychotics—significantly reshape the composition, diversity, and functional capacity of the gut microbial community. These interactions are bidirectional: pharmacotherapy influences the microbiome, while the microbiome modulates drug efficacy, pharmacokinetics, pharmacodynamics, and toxicity. This narrative review examined scientific evidence published between 2005 and 2025 addressing the effects of four major therapeutic classes on the gut microbiome, their metabolic consequences, and resulting clinical implications. Findings indicate that drug-induced dysbiosis may contribute to systemic inflammation, increased susceptibility to infections, alterations in the gut–brain axis, metabolic disorders, and variability in therapeutic response. Conversely, microbiome-modulating interventions — including probiotics, prebiotics, synbiotics, postbiotics, and fecal microbiota transplantation — emerge as promising strategies to restore eubiosis and improve clinical outcomes. Recognizing the microbiota as a “functional organ” highlights the need to integrate microbiome-based analyses into personalized medicine, seeking safer, more effective, and individualized therapies.