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      The gastrointestinal microbiota as a site for the biotransformation of drugs.

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          Abstract

          There are 100 trillion microbes in the human gastrointestinal tract with numbers increasing distally. These microbiota secrete a diverse array of enzymes (primarily for carbohydrate and protein fermentation) giving them substantial metabolic potential which can have major implications for drug stability. At least thirty drugs which are, or have been, available commercially, were subsequently shown to be substrates for these bacterial enzymes, and with increasing numbers of new and existing drugs having the potential for contact with the distal gut (through modified release systems or poor solubility/permeability), many more are expected to be discovered. The major concern with bacterial drug degradation is the behaviour of the metabolite; is it more or less active than the parent compound, or has toxicity resulted? For example, there were eighteen deaths in 1993 due to a drug interaction in which a toxic drug metabolite was produced by bacterial fermentation. Thus, the objective of this review is the provision of a comprehensive overview of this area; the gastrointestinal microbiota, their drug substrates and metabolic mechanisms, and approaches to studying this further are discussed.

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          Author and article information

          Journal
          Int J Pharm
          International journal of pharmaceutics
          Elsevier BV
          0378-5173
          0378-5173
          Nov 03 2008
          : 363
          : 1-2
          Affiliations
          [1 ] Department of Pharmaceutics, The School of Pharmacy, University of London, London, UK.
          Article
          S0378-5173(08)00498-5
          10.1016/j.ijpharm.2008.07.009
          18682282
          f2b5081f-da09-4605-b2ab-142c0d92dcdf
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