From microbiome to outcome: the cascading effects of combining acid suppressants with anti-tuberculosis therapy

Gastrointestinal adverse reactions occur in up to 71.8% of patients receiving anti-tuberculosis drugs. Anti-tuberculosis drugs alone reduce gut microbial diversity, deplete short-chain fatty acid-producing bacteria, and promote opportunistic pathogen overgrowth. Acid-suppressing agents, particularly proton pump inhibitors, raise stomach pH and facilitate bacterial translocation from the mouth to the gut, independently disrupting microbiota composition. The article examines the effects of anti-tuberculosis drugs and acid suppressants on gut microbiota and proposes a theoretical cascade with combined use: synergistic microbiota depletion, dual metabolic pathway inhibition, and immune homeostasis imbalance. The authors recommend that clinicians strictly follow indications for acid suppressants, prefer H2 receptor antagonists over proton pump inhibitors, and limit treatment to the shortest effective duration. Large-scale prospective studies are needed to confirm these hypotheses.