How do drugs affect the microbiota? And can bacteria themselves change the effectiveness and absorption of drugs? We answer these and other questions in the article.

What is pharmacomicrobiomics
It is known that the microbiota plays a huge role in the body and affects digestion, the functioning of the immune system, the endocrine system and even the psychological state of a person. Almost everything affects the balance of the microbiota itself: environmental changes, lifestyle, nutrition and medications.
Pharmacomicrobiomics is a branch of science that studies how drugs affect the microbiota and how this, in turn, affects the effectiveness of drugs for each individual. Experts are not yet able to describe in detail and accurately how the microbiota and drugs interact with each other. Scientists believe that in the future, pharmacomicrobiomics will help, firstly, to better understand how each patient's body responds to a particular therapy, and secondly, doctors will be able to increase the effectiveness of drugs by changing the composition of the microbiota.

The influence of microbiota on drugs
The body's individual response to treatment can vary significantly from patient to patient. Thus, experts say that taking many drugs is often ineffective, since their effectiveness is lost when interacting with the microbiota; the effectiveness of many drugs is often 50-75% less, which is due to improper interaction with the microbiota in a particular patient (for example, the bacterium Eggerthella lentum causes the loss of effectiveness of digoxin, a drug for treating arrhythmia, which reduces the strength of its binding to its target). Therefore, more than half of people often do not benefit from taking medications as much as they were expected before starting treatment. In addition, the manifestations of adverse reactions are also unpredictable. Doctors believe that the composition of the microbiota may play an important role in all these variations.

Microbiota and drugs for immunotherapy
Microbiota and immunity are closely related: for example, some types of bacteria can influence the appearance of immune cells (for example, T-helpers 17), which are associated with the development of autoimmune diseases - multiple sclerosis, rheumatoid arthritis, psoriasis, and others. Other bacteria (for example, Bacteroides fragilis) can, on the contrary, suppress autoimmune inflammatory diseases.
One of the methods of combating cancerous tumors is immunotherapy. Special drugs help the human immune system to better recognize tumors and attack them faster, and generally strengthen the body's natural defenses. The effectiveness of immunotherapy largely depends on the type of tumor and the stage of the disease. Studies in mice and humans have shown that the outcome of treatment can be largely determined by the composition of the microbiota. Thus, in patients with a good response to immunotherapy, the number of bacteria (for example, bifidobacteria, lactobacilli, ackermansia, ruminococcus) is higher than average. Experts emphasize that the available data are not yet sufficient to suggest that the composition of the microbiota can improve the effectiveness of immunotherapy. This requires clinical trials that take into account not only the treatment of different types of tumors, but also other factors, such as the intake of other drugs and concomitant diseases, diet, lifestyle and the psychological state of the person.

Microbiota and the treatment of arterial hypertension
Arterial hypertension is a condition in which a person has high blood pressure. It is a very common condition that significantly reduces the quality of life and can also lead to serious complications: problems with the cardiovascular system, which in some cases can be life-threatening.
Studies in mice and humans have shown that the composition of the microbiota in patients with hypertension differs from that of healthy people, to the extent that scientists were able to correctly identify the presence of hypertension in patients in 83% of cases based on data on the diversity of intestinal microbes. The body of healthy people contains more bacteria responsible for the production of butyric and propionic acids (e.g., Eubacteria, Akkermansia, Bacteroides). On the other hand, the intestines of people with high blood pressure have more streptococci, enterococci, and synechococcus. Scientists believe that the disturbed balance of bacteria leads to inflammatory processes, the formation of harmful compounds for the body (for example, trimethylamine). All of these processes contribute to the development of arterial hypertension.
In addition, recent studies have shown that the disturbed microbiota also affects how the body responds to drugs to reduce pressure. The effectiveness of these drugs is affected by enzymes - protein compounds produced by certain bacteria, such as coprococci. As with immunotherapy, scientists do not yet have enough data on the microbiota