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Recent advances in clinical practice
Antibiotics as deep modulators of gut microbiota: between good and evil
  1. Gianluca Ianiro1,
  2. Herbert Tilg2,
  3. Antonio Gasbarrini1
  1. 1Internal Medicine, Gastroenterology and Liver Unit, “Agostino Gemelli” University Hospital, Catholic University of Rome, Italy
  2. 2Department of Internal Medicine I, Gastroenterology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria
  1. Correspondence to Professor Antonio Gasbarrini, Internal Medicine, Gastroenterology and Liver Unit, “Agostino Gemelli” University Hospital, Largo A. Gemelli, Rome 00168, Italy; antonio.gasbarrini{at}


The recent increase in our knowledge of human gut microbiota has changed our view on antibiotics. Antibiotics are, indeed, no longer considered only beneficial, but also potentially harmful drugs, as their abuse appears to play a role in the pathogenesis of several disorders associated with microbiota impairment (eg, Clostridium difficile infection or metabolic disorders). Both drug-related factors (such as antibiotic class, timing of exposure or route of administration) and host-related factors appear to influence the alterations of human gut microbiota produced by antibiotics. Nevertheless, antibiotics are nowadays considered a reliable therapy for some non-communicable disorders, including IBS or hepatic encephalopathy. Moreover, some antibiotics can also act positively on gut microbiota, providing a so-called ‘eubiotic’ effect, by increasing abundance of beneficial bacteria. Therefore, antibiotics appear to change, for better or worse, the nature of several disorders, including IBS, IBD, metabolic disorders or liver disease. This reviews aims to address the potential of antibiotics in the development of major non-communicable disorders associated with the alteration of gut microbiota and on newly discovered therapeutic avenues of antibiotics beyond the cure of infectious diseases.

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  • Twitter Follow Gianluca Ianiro at @gianluca1aniro

  • Contributors Drafting of the manuscript; critical revision of the manuscript for important intellectual content: all authors.

  • Funding HT is supported by the excellence initiative (Competence Centers for Excellent Technologies—COMET) of the Austrian Research Promotion Agency FFG: Research Center of Excellence in Vascular Ageing Tyrol, VASCage (K-Project Nr. 843536) funded by the BMVIT, BMWFW, the Wirtschaftsagentur Wien and the Standortagentur Tirol.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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