Antibiotic use and its consequences for the normal microbiome
Open accessAbstract
Anti-infectives, including antibiotics, are essentially different from all other drugs; they not only affect the individual to whom they are given but also the entire community, through selection for resistance to their own action. Thus, their use resides at the intersection of personal and public health. Antibiotics can be likened to a four-edged sword against bacteria. The first two edges of the antibiotic sword were identified immediately after their discovery and deployment in that they not only benefit an individual in treating their infection but also benefit the community in preventing the spread of that infectious agent. The third edge was already recognized by Alexander Fleming in 1945 in his Nobel acceptance speech, which warned about the cost to the community of antibiotic resistance that would inevitably evolve and be selected for during clinical practice. We have seen this cost mount up, as resistance curtails or precludes the activities of some of our most effective drugs for clinically important infections. But the fourth edge of the antibiotic sword remained unappreciated until recently, i.e., the cost that an antibiotic exerts on an individual's own health via the collateral damage of the drug on bacteria that normally live on or in healthy humans: our microbiota. These organisms, their genes, metabolites, and interactions with one another, as well as with their host collectively, represent our microbiome. Our relationship with these symbiotic bacteria is especially important during the early years of life, when the adult microbiome has not yet formed.
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Antibiotics are blunt tools of mass microbial destruction that can permanently alter the microbiome and predispose to diseases such as obesity and diabetes.
“In current use, antibiotics are blunt tools of mass microbial destruction that can permanently alter the microbiome and predispose to numerous diseases such as obesity and diabetes[421].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [421]
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- Authors
- Blaser, M. J.
- Affiliations
- VA NY Harbor Healthcare System (US)
- Corresponding author
- Blaser, Martin J.
- ORCID
- Blaser, Martin J.
- Venue
- Science
- Published
- 2016-04-29
- Volume
- 352
- Issue
- 6285
- Pages
- 544-545
- ISSN
- 0036-8075 (ISSN-L)
- 1095-9203
- PMC
- PMC4939477
- OpenAlex
- W2344149427
- Cited by
- 836
- References
- 15
- Citations by year
- 2026: 52 · 2025: 73 · 2024: 84 · 2023: 81 · 2022: 106 · 2021: 110 · 2020: 84 · 2019: 80 · 2018: 78 · 2017: 64 · 2016: 24
- FWCI
- 42.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Science (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- Funders
- NIH (R01DK090989, U01AI122285)
- Diane Belfer Program in Human Microbial Ecology
- Knapp Family Fund
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Keywords
- antibiotic use, gut microbiota, microbiota, antibiotic resistance, antimicrobial stewardship
- MeSH terms
- Anti-Bacterial Agents, Bacteria, Drug Utilization, Humans, Drug Resistance, Bacterial, Microbiota
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