Medical Bulletin 12/August/2025 - Video

Common Non-Antibiotic Drugs May Harm Gut Microbiome and Raise Infection Risk

A new study published in the journal Nature reveals that several widely prescribed non-antibiotic drugs can significantly disrupt the gut microbiome and increase the risk of gastrointestinal (GI) infections. Conducted by researchers at Yale University, the study highlights that these medications—though not intended to target bacteria—can have unintended consequences on gut health, similar to those caused by antibiotics.

While antibiotics are known to disrupt gut bacteria, this study reveals that some non-antibiotic drugs can also disturb the microbiome. In some cases, they trigger the body to produce antimicrobial agents that harm beneficial gut bacteria, weakening the gut’s natural defense and increasing infection risk.

To better understand the link between drug use and infection risk, the researchers analysed over a decade of health records and pharmacy claims from one million individuals enrolled in a universal health insurance program in Canada. They identified several non-antibiotic prescription drugs that raised the risk of GI infections to a degree comparable with antibiotics.

From their findings, the researchers selected 21 commonly used drugs for further investigation. Using a controlled laboratory setting, mice were treated with these medications, and changes in gut microbiota were analysed through faecal samples collected before and after treatment. Approximately half of the drugs tested were found to significantly alter the composition of the gut microbiome.

Among the most concerning were four specific drugs—digoxin, clonazepam, pantoprazole, and quetiapine—which not only disrupted gut bacteria but also increased the mice’s susceptibility to infections when exposed to pathogens.

These findings point to a growing need for clinicians and researchers to consider the unintended impact of non-antibiotic drugs on gut health. As medication responses vary among individuals, the study suggests the gut microbiome could play a key role in predicting and improving drug outcomes. Further research may pave the way for microbiome-friendly therapeutic strategies in the future.

Reference: Kumar, A., Sun, R., Habib, B. et al. Identification of medication–microbiome interactions that affect gut infection. Nature (2025). https://doi.org/10.1038/s41586-025-09273-8

Diabetes Affects 1 in 5 Indians Over 45, Urban Areas Hit the Hardest: Lancet Study

Nearly one in every five Indians aged 45 years and older had diabetes in 2019, with urban prevalence almost twice as high as rural, according to a major study published in The Lancet Global Health journal. The study also found that nearly 40% of individuals with diabetes were unaware of their condition, raising concerns about underdiagnosis and the growing burden of non-communicable diseases in India.

The study defined diabetes based on self-reported diagnosis or HbA1c levels of 6.5% or higher. “In 2019 approximately one in five people aged 45 years and older had diabetes in India (19.8%), which amounts to 50.4 million individuals. Two out of five people with diabetes (40%) were unaware of their condition,” the authors reported.

The study drew from the Longitudinal Aging Study in India (LASI), a cross-sectional, nationally representative survey conducted from 2017 to 2019. Researchers surveyed 57,810 adults and their spouses across all 36 states and union territories. Participants had data available on HbA1c levels, body mass index, household income, and self-reported diabetes diagnoses.

The findings also revealed stark contrasts between urban and rural populations. While 30% of urban adults over 45 had diabetes, only 15% of their rural counterparts were affected. Prevalence was also higher in more economically developed regions and among overweight (24.7%) and obese individuals (34.6%). Diabetes rates were similar among men and women.

Notably, only 46% of individuals with diabetes had controlled blood sugar levels, 59% achieved blood pressure control, and just 6% were taking lipid-lowering medication to reduce cardiovascular risk.

These numbers fall significantly short of the WHO Global Diabetes Compact targets for 2030, which aim for at least 80% of diabetes cases to be diagnosed and treated effectively.

“Up to date evidence on the prevalence, awareness, treatment, and control of diabetes among middle-aged and older adults is important given that the risk of diabetes increases with age and that clinical and public health interventions can help to prevent diabetes complications,” the authors said.

The authors stressed the urgent need for stronger policies to improve prevention, screening, and management of diabetes in India’s ageing population.

Reference: Prevalence, awareness, treatment, and control of diabetes in India: a nationally representative survey of adults aged 45 years and older, Sekher, T V et al. The Lancet Global Health, Volume 0, Issue 0

Lancet Commission Urges Global Action to Curb Rising Liver Cancer Burden by 2050

In a major report published in The Lancet, an international Commission has called for urgent and coordinated action to tackle hepatocellular carcinoma (HCC)—the most common form of liver cancer, responsible for around 80% of all liver cancer cases. The report, presents a global roadmap to reduce the rising disease burden associated with hepatocellular carcinoma, currently the third leading cause of cancer-related deaths worldwide.

The Commission, comprised of experts across clinical medicine, public health, and policy, conducted a comprehensive review that involved literature analysis, evidence scoping, data synthesis, modeling, and real-world case studies. Their goal was to project the global trajectory of hepatocellular carcinoma through 2050 and establish measurable targets to mitigate its impact.

One of the key findings of the report is the need for an annual reduction of at least 2% in age-standardized liver cancer incidence rates to effectively curb the disease burden. Encouragingly, the report notes that “based on a conservative estimate, at least 60% of liver cancer is preventable via control of these risk factors,” particularly hepatitis B and C infections and alcohol use.

To achieve these goals, the Commission outlines ten evidence-based recommendations, centered on prevention, early detection, and treatment. These include scaling up viral hepatitis screening and treatment, reducing alcohol consumption through policy measures, and addressing environmental hazards like contaminated water. The report also highlights the rising threat of liver diseases such as MASLD and MASH, advocating for integrated strategies to combat them.

For improved outcomes, the authors stress enhanced surveillance in high-risk populations and equitable access to care, especially in low- and middle-income countries.

Reference: The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment, Chan, Stephen Lam et al. The Lancet, Volume 0, Issue 0