Pharmacomicrobiomics: Understanding Drug–Microbiota Interactions for Precision Medicine

Abstract

The complex ecosystem of human-associated microorganisms is now recognized as a critical factor influencing how individuals respond to therapeutic drugs. The gut microbiota, in particular, possesses enzymatic functions that can transform various compounds, often altering their intended pharmacological effects. This review explores the mechanisms through which the microbiota mediates drug transformation, including reduction, hydrolysis, and deconjugation, and how these interactions shape inter-individual variability in treatment response. Notably, several commonly prescribed drugs can in turn disrupt microbial equilibrium, leading to imbalances that affect both gastrointestinal and systemic health. Recent studies have suggested that targeted microbial interventions, such as probiotic and synbiotic supplementation, can support the restoration of microbial harmony and potentially improve drug tolerability and effectiveness. Applications of this approach are increasingly being investigated across a wide array of fields, including cancer therapy, mental health, infectious diseases, and autoimmune conditions. A deeper understanding of these interactions holds promise for shaping personalized treatment strategies that account for the patient’s unique microbial profile.