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Antibiotic perturbations to the gut microbiome
Open accessAbstract
Antibiotic-mediated perturbation of the gut microbiome is associated with numerous infectious and autoimmune diseases of the gastrointestinal tract. Yet, as the gut microbiome is a complex ecological network of microorganisms, the effects of antibiotics can be highly variable. With the advent of multi-omic approaches for systems-level profiling of microbial communities, we are beginning to identify microbiome-intrinsic and microbiome-extrinsic factors that affect microbiome dynamics during antibiotic exposure and subsequent recovery. In this Review, we discuss factors that influence restructuring of the gut microbiome on antibiotic exposure. We present an overview of the currently complex picture of treatment-induced changes to the microbial community and highlight essential considerations for future investigations of antibiotic-specific outcomes. Finally, we provide a synopsis of available strategies to minimize antibiotic-induced damage or to restore the pretreatment architectures of the gut microbial community.
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“Median times to pathogen identification with standard techniques have been reported near 96 h, a critical window during which unnecessary antimicrobial exposure can increase adverse events and the risk of colonization by resistant organisms (3–5).”
From Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy (2026) · cites this paper as [4]
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“2,3 Moreover, these compositional changes can remain long after cessation of antimicrobials.”
Moya‐Salazar, J., Terán-Vásquez, A., Salazar-Hernández, R., Rojas-Zumarán, V., Goicochea‐Palomino, E. A., Moya-Salazar, M. M., & Contreras-Pulache, H. (2025) · Antibiotics · doi:10.3390/antibiotics14070636 · Cited by 1
“Fourth, it is possible that dietary variation may influence the effect of FZD in vivo, as this factor can affect the microbial environment and therapeutic outcomes [33].”
Microbial profile of the appendix niche in acute appendicitis: a novel sampling approach
Ma, H., Wang, M., Feng, Y., Zhang, W., Wang, W., Xie, Y., Kong, G., Feng, J., Wang, P., Wang, Q., et al. (2025) · FEBS Open Bio · doi:10.1002/2211-5463.70105 · Cited by 1
“Other factors such as diet, antibiotic administration, and bowel preparation, that should be taken into the consideration [63,64].”
Lin, H., Lin, H.-T., Chiang, Y.-R., Lu, Y.-Y., Pan, J., Chen, M., Chuang, J.-C., Lin, H.-J., Kuo, W.-C., Lin, H.-J., et al. (2025) · Aquaculture · doi:10.1016/j.aquaculture.2025.743113 · Cited by 1
Lau, R. I., Wong, M. C. S., Lau, L. H. S., Lau, A. Y. L., Mak, I. W. C., Lo, O. S., Chan, N. N., Dai, D. L. K., & Hau, K. C. (2025) · Gut Microbes Reports · doi:10.1080/29933935.2025.2558575 · Cited by 2
“21,41 The second feature is the increase in pathogenic microbial metabolites or products, for instance, lipopolysaccharides (LPS), a bacterial endotoxin that could trigger inflammation when it crosses the gut barrier and enters the bloodstream, leading to both local and systemic effects.”
Tian, R., Hu, X., Yu, L., Tian, F., Zhao, J., Zhai, Q., & Chen, W. (2025) · Food Science and Human Wellness · doi:10.26599/fshw.2025.9250793 · Cited by 1
Understanding the impact of antibiotic treatment on the diversity of gut microbiota species
Charitos, I. A., Santacroce, L., Topi, S., Potenza, M. A., Montagnani, M., & Colella, M. (2025) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2025.2579881 · Cited by 1
Ossandón-Pino, N., Musleh-Vega, S., Pacheco, J. M., Retamal-Fredes, E., Romero, F. E., Guzmán, C., Hepp, M. I., Castro, C., Fehlings, M. G., Ávila, A., et al. (2025) · Molecular Neurobiology · doi:10.1007/s12035-025-05339-w · Cited by 1
“The unintended consequences of antibiotic treatments, such as off-target effects and microbiota perturbations, are well documented [44].”
Baral, T., Maile, A., Nagarajaram, H. A., Saravu, K., Kudru, C. U., Singh, J., Mukhopadhyay, C., Rao, M., Manu, M. K., & Miraj, S. S. (2025) · PLoS ONE · doi:10.1371/journal.pone.0336337 · Cited by 1
Jiang, Y., Liu, Y., Ma, F., Qiu, W., & Wang, G. (2025) · LWT · doi:10.1016/j.lwt.2025.118932 · Cited by 1
The characteristics of the gut microbiota in patients with Kawasaki disease: a systematic review
Chen, H., Liu, H., Qiao, L., Liu, Y., Yu, D., Wang, Z., Wang, T., & Li, W. (2025) · Frontiers in Microbiology · doi:10.3389/fmicb.2025.1715478 · Cited by 1
“However, it is well established that antibiotics can disrupt gut microbial communities, specifically by reducing diversity and altering community structure (Fishbein et al., 2023).”
Microbial Metabolism of Levodopa as an Adjunct Therapeutic Target in Parkinson’s Disease
Feix, J. B., Cheng, G., Hardy, M., & Kalyanaraman, B. (2026) · Antioxidants · doi:10.3390/antiox15010120 · Cited by 2
“Although tetracycline antibiotics (doxycycline, minocycline) have shown neuroprotective effects in mouse models of PD [64,65], treatment with conventional antibiotics can seriously disrupt the normal microbial flora, enabling proliferation of drug-resistant, pathogenic bacteria [66–68].”
Akhtara, N., & Bharali, M. K. (2026) · Chemico-Biological Interactions · doi:10.1016/j.cbi.2026.111939 · Cited by 1
Bastard, Q. L., Gschwind, R., Lao, J., Vibet, M., Batard, É., Corvec, S., Montassier, E., & Ruppé, É. (2026) · Gut Microbes · doi:10.1080/19490976.2026.2627692 · Cited by 2
Prebiotic efficacy of green banana flour against antibiotic-associated diarrhea in juvenile mice
Fu, Z., Wang, X., Yang, L., Xia, D., Song, Y., Xv, F., Chen, M., Zhong, F., & Liu, F. (2026) · Food Bioscience · doi:10.1016/j.fbio.2026.108436 · Cited by 1
Huang, D., Fu, L., Wang, Y., Zou, K., Zou, R., Tang, Y., & Zhang, Z. (2026) · Naunyn-Schmiedeberg s Archives of Pharmacology · doi:10.1007/s00210-026-05066-6 · Cited by 1
“Furthermore, they eliminate their inherent competitive inhibition effect, leading to the overgrowth of opportunistic pathogens (such as MRSA and Pseudomonas aeruginosa ) (Fishbein et al. 2023).”
Yang, Y., Luo, X., Lu, D., Du, P., Jier, S., Wu, X., Lv, Y., Dong, P., & Ding, X. (2026) · Microorganisms · doi:10.3390/microorganisms14030575 · Cited by 1
“AAs can participate in the modification of lignin, thus breaking the barrier of plant biomass resistance to degradation and accelerating substrate hydrolysis [43].”
Li, X., Sun, H., Yang, X., Feng, L., Niu, Y., Xiang, B., Qin, J., Wang, J., Li, Z., Wang, L., et al. (2026) · Nature Communications · doi:10.1038/s41467-026-70257-x · Cited by 1
“While conventional antibiotics can combat bacterial infections, they often indiscriminately disrupt the gut microbiota, eliminating bene fi cial bacteria that are essential for gut health 55 .”
Chen, Z., Ye, X., Wu, J., Li, Z., Wang, S., Wang, J., Tian, Y., Li, S., Zhou, L., Ni, J., et al. (2026) · Annals of Intensive Care · doi:10.1016/j.aicoj.2026.100063 · Cited by 1
The impact of antibiotic exposure on obesity and metabolic phenotypes via the gut microbiota
Zhu, B., Fu, C., Fan, D., Wang, Y., Sheng, P., Feng, J., & Wang, X. (2026) · Frontiers in Microbiology · doi:10.3389/fmicb.2026.1782016 · Cited by 3
“Previous studies have indicated that following antibiotic exposure, the gut microbiota typically exhibits rapid declines in α -diversity and alterations in β -diversity (Fishbein et al., 2023; Anthony et al., 2022).”
Zhang, B., Guo, S., Li, M., Niu, Y., Liu, Y., Wu, N., Zhu, H., & Cui, Y. (2026) · Microorganisms · doi:10.3390/microorganisms14040888 · Cited by 1
“Such selective pressure could lead to a higher prevalence of resistant strains in the gut in these individuals [50].”
A One Health Perspective on Cancer: A Narrative Review
Duarte, S. A. C., Pinto‐Leite, R., & QUEIROGA, F. L. (2026) · Medical Sciences · doi:10.3390/medsci14020221 · Cited by 2
“However, disruptions from infection [190], antibiotic overuse [191], or unhealthy lifestyle behaviors, including diets high in processed foods and low in fiber, physical inactivity and nicotine exposure [192], can cause microbial dysbiosis, an imbalance linked to chronic inflammation, immune…”
Huang, Y., Hong, L., Li, S., Zhang, L., Guo, X., Han, J., Yu, W., Chen, H., Luo, N., Chen, J., et al. (2026) · npj Biofilms and Microbiomes · doi:10.1038/s41522-026-01008-5 · Cited by 1
The role of the gut microbiome in antibiotic-driven antimicrobial resistance
Joshi, G., Rani, S., Bharti, D., Panda, N., Chavan, P., Mathpal, S., Ramaiah, S., & Anbarasu, A. (2026) · Frontiers in Microbiology · doi:10.3389/fmicb.2026.1856738 · Cited by 3
Ecological Constraint and Functional Response in Microbiome-informed Integrative Medicine
Lewandowski, R. (2026) · Future Integrative Medicine · doi:10.14218/fim.2026.00004 · Cited by 1
Estimating Sparse Direct Effects in Multivariate Regression With the Spike-and-Slab LASSO
Shen, Y., Solís‐Lemus, C., & Deshpande, S. K. (2024) · Bayesian Analysis · doi:10.1214/24-ba1430 · Cited by 1
Wang, W., Geng, Y., Pan, J., & Zhang, X. (2025) · Gastroenterology · doi:10.1053/j.gastro.2024.12.038 · Cited by 1
Ma, C., Zhang, M., Chen, B., Liu, M., Jiang, H., Li, J., Song, X., Wei, X., Wei, Z., Liu, J., et al. (2025) · Health Science Reports · doi:10.1002/hsr2.71109 · Cited by 1
The Microbiota Dynamics in Water Distribution System of Pig FarmPreprint
Ren, Q., Chen, D., Cao, S., Li, X., Wang, M.-G., Teng, J., Du, X., Huang, Y., Gao, X., Liu, C., et al. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4760755 · Cited by 1
Bacterial microcompartment utilisation in the human commensal Escherichia coli Nissle 1917Preprint
Clare, C., Rutter, J. W., Fedorec, A. J. H., Frank, S., & Barnes, C. P. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.05.13.593892 · Cited by 1
Han, M., Wang, X., Su, L., Pan, S., Liu, N., Duan, L., Liu, L., Cui, J., Zhao, H., & Yang, F. (2024) · eLife · doi:10.7554/elife.99282.1 · Cited by 1
Gut Microbiome Perturbation Affected Conjugative Transfer of Antimicrobial Resistance GenesPreprint
Yilmaz, G., Chan, M., Lau, C. H., Capitani, S., Kang, M., Charron, P., Hoover, E., Topp, E., & Guan, J. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.08.03.605226 · Cited by 1
“Likely, these bacteria can tolerate antibiotics through spore-mediated persistence, intrinsic resistance and/or other resiliency mechanisms [34].”
Background
Metadata
- Authors
- Fishbein, S. R. S., Mahmud, B., & Dantas, G.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Dantas, Gautam
- Venue
- Nature Reviews Microbiology
- Published
- 2023-07-25
- Volume
- 21
- Issue
- 12
- Pages
- 772-788
- ISSN
- 1740-1526 (ISSN-L)
- 1740-1534
- PMC
- PMC12087466
- OpenAlex
- W4385240643
- Cited by
- 440
- References
- 229
- Citations by year
- 2026: 152 · 2025: 165 · 2024: 115 · 2023: 7
- FWCI
- 11.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Nature Reviews Microbiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health
- Centers for Disease Control and Prevention (R01OH011578)
- Agency for Healthcare Research and Quality (R01 HS027621)
- National Institute of Allergy and Infectious Diseases (U01AI123394, R01AI155893)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK077653)
- National Institute for Occupational Safety and Health (R01 OH011578)
- National Center for Complementary and Integrative Health (R01AT009741)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD092414)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Physical Sciences › Environmental Science › Ecology › Microbial Community Ecology and Physiology
- Keywords
- gut microbiota, antibiotics, microbiome perturbation, microbiome recovery, gastrointestinal diseases, autoimmune disease, multi-omics profiling
- MeSH terms
- Gastrointestinal Microbiome, Anti-Bacterial Agents, Gastrointestinal Tract, Microbiota
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