Microbiotoxicity: an under-recognised player in drug efficacy, toxicity, and health outcomes

The gut microbiome regulates immunity, inflammation, and metabolism. Disruption by antibiotic and non-antibiotic drugs, termed microbiotoxicity, may impair efficacy of treatments, including cancer immunotherapy and vaccination, and contribute to antimicrobial resistance (AMR). This review explores microbiotoxicity's clinical impacts, highlighting non-antibiotic drug effects. Further research into drug-microbiome interactions in future may help inform prescribing practices and drug development as a way to improve health outcomes, reduce toxicity, and support AMR stewardship.