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The unique array of bacteria in a person’s gut can dramatically change how well they metabolize medicines, and could explain why some patients respond better to some drugs, according to a new study that examined the impact of the microbiome on more than 500 medicines.

The research, published Wednesday in Cell, is the first to look at how a patient’s full microbiome affected the breakdown of more than 500 different drugs. Earlier research published in Nature had examined the isolated impact of about 70 individual strains of bacteria on drug metabolization.


The researchers found that a patient’s microbiome altered 57 existing oral medications; for 45 of those medicines, including the anti-cancer drug capecitabine, the microbiome’s role in metabolizing the medicine wasn’t known previously. The authors claim their method can be replicated to test how the full microbiome affects the efficacy and side effects of other existing treatments or experimental therapies.

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