Rethinking antimicrobial stewardship paradigms in the context of the gut microbiome

Farah Shahi; Kelly Robert Redeker; James Paul Jonathan Chong

doi:10.1093/jacamr/dlz015

Rethinking antimicrobial stewardship paradigms in the context of the gut microbiome

Farah Shahi, Kelly Robert Redeker, James Paul Jonathan Chong

Biology

Research output: Contribution to journal › Article › peer-review

Abstract

Ongoing concerns over the presence and persistence of antimicrobial resistance (AMR), particularly in Gram-negative bacteria, continue to have significant global health impacts. The gastrointestinal tract, or ‘gut’, environment amplifies AMR in the human gut microbiome, even in the absence of antibiotics. It constitutes a complex and diverse community of organisms, and patterns and alterations within it are increasingly being found to be associated with states of health and disease. Our understanding of the effects of routes of administration of antimicrobials on the gut microbiome is still lacking despite recent advances in metagenomics. In this article we review current evidence for antibiotic effects on gut microbiota and explore possible prescribing and stewardship approaches that would seek to minimize these effects. If we are to preserve existing and new antimicrobials, we need to consider their use in the context of their effect on gut ecology, and the human microbiome in general.

Original language	English
Journal	JAC-Antimicrobial Resistance
Volume	1
Issue number	1
DOIs	https://doi.org/10.1093/jacamr/dlz015
Publication status	Published - 21 May 2019

Bibliographical note

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10.1093/jacamr/dlz015

Rethinking antimicrobial stewardship paradigms in the context of the gut microbiome
© The Author(s) 2019
Final published version, 232 KBLicence: CC BY

Cite this

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AB - Ongoing concerns over the presence and persistence of antimicrobial resistance (AMR), particularly in Gram-negative bacteria, continue to have significant global health impacts. The gastrointestinal tract, or ‘gut’, environment amplifies AMR in the human gut microbiome, even in the absence of antibiotics. It constitutes a complex and diverse community of organisms, and patterns and alterations within it are increasingly being found to be associated with states of health and disease. Our understanding of the effects of routes of administration of antimicrobials on the gut microbiome is still lacking despite recent advances in metagenomics. In this article we review current evidence for antibiotic effects on gut microbiota and explore possible prescribing and stewardship approaches that would seek to minimize these effects. If we are to preserve existing and new antimicrobials, we need to consider their use in the context of their effect on gut ecology, and the human microbiome in general.

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