The use of antimicrobials as adjuvant therapy for the treatment of obesity and insulin resistance: Effects and associated mechanisms

The intestinal microbiota has come to be considered an additional risk factor for the development of metabolic diseases. Considering the potential role of antimicrobials as modulators of the intestinal microbiota, they have been investigated for use in the adjuvant treatment of obesity and insulin resistance (IR). In this regard, the present manuscript aimed to review the effect of regular use of antimicrobials on the treatment of obesity and/or IR, as well as its associated mechanisms. The regular use of antimicrobials does not seem to influence the body weight and adiposity of its consumer. Regarding IR, clinical trials did not observe positive effects, on the other hand, most of the experimental studies observed an increase in insulin sensitivity. The mechanisms used by antimicrobials that could lead to the improvement of insulin sensitivity are dependent on the modulation of the intestinal microbiota. This modulation would lead to a reduction in the stimulation of the immune system, as a consequence of improved intestinal barrier and/or the reduction of gram-negative bacteria in the microbiota. In addition, the secretion of glucagon-like peptide-1 would be modulated by metabolites produced by the intestinal microbiota, such as secondary bile acids and short-chain fatty acids. Based on the results obtained to date, more studies should be performed to elucidate the effect of these drugs on obesity and IR, as well as the mechanisms involved. In addition, the cost-benefit of the regular use of antimicrobials should be investigated, as this practice may lead to the development of antimicrobial-resistant microorganisms.