The endoscopist noted the long-term effect of drugs on the intestinal microbiota

Current research shows that the effect of drugs on the gut microbiota can be long-term and is not limited to antibiotics alone. This was told to Izvestia on October 13 by an endoscopist at the KDC NCC No. 2 of the Federal State Budgetary Scientific Institution "RNC named after Academician of B.V. Petrovsky" Sergey Lataev.

"In my practice, I see the condition of the intestinal mucosa in hundreds of patients every day, and the issue of microbiota health is not abstract for me, but is directly related to what I see on the monitor during research. The data obtained is extremely important for rethinking our approach to prescribing medicines," Lataev said.

A study from the University of Tartu confirms what gastroenterologists have long suspected: the effects of medication on the intestinal microbial community may not be a short-term episode, but a long-term "reprogramming." After a short course of antibiotics, some bacteria can recover in a few weeks, but a complete return to their original species diversity can take months, and sometimes even years.

As the doctor noted, some stamps of beneficial bacteria may be lost forever. As for other drugs, such as antidepressants and beta blockers, the evidence that their effects can persist for years is a new and alarming signal. Even after the drug is discontinued, a kind of "metabolic trace" may remain in the body, affecting health. Many medications that are not intended for the intestine pass through it in transit or are excreted with bile, directly contacting the microflora.

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"But the mechanism is more complicated. Antidepressants, anxiety medications, and beta blockers affect the nervous system. And there is a direct connection between the brain and the gut — the "brain-gut-microbiota" axis. By changing the state of the nervous system, drugs change intestinal motility, blood supply and secretion, creating a new habitat for bacteria, in which some species begin to prevail and others die," Lataev explained.

Microbiota restoration is a complex and individual process, but it is possible. The most radical and effective method today is fecal microbiota transplantation (TFM), when a balanced community of bacteria is transferred from a carefully examined healthy donor into the patient's intestine. This method is used, for example, "for recurrent C. difficile infections, and in the future it may be used to correct the effects of drug therapy."

Specially selected probiotics and prebiotics can also help, but there is no universal pill: the selection must be individual, and the effectiveness of pharmacy probiotics is often limited. The diet remains the cornerstone: a varied diet with an abundance of fiber — vegetables, fruits, whole grains, as well as fermented foods such as kefir, sauerkraut or yogurt without sugar, creates optimal conditions for the growth of its own beneficial microflora.

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"This study is another strong argument in favor of personalized medicine. The principle of "do no harm" is reaching a new level. When prescribing any drug, especially long-term courses, doctors should think not only about the direct indications and contraindications, but also about its potential effect on the microbiome. This is especially true for patients with pre—existing gastrointestinal problems," Lataev emphasized.

The endoscopist concluded that in the future, before prescribing therapy, it may be advisable to analyze the initial state of the patient's microbiota in order to predict risks and side effects. Even now, when prescribing antibiotics, patients are advised to discuss with their doctor a strategy for supporting and restoring the microbiota through diet and, if necessary, probiotics.

The journal Science Daily reported that medications taken even many years ago can continue to affect the intestinal microflora. Scientists have found that most drugs leave an imprint in the microbiome that persists long after the end of treatment.

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