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The effect of commonly used non-antibiotic medications on antimicrobial resistance development in Escherichia coli

Hanbiao Chen1, Sylvia A Sapula1, John Turnidge2

  • 1UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA, Australia.

Npj Antimicrobials and Resistance
|August 25, 2025
PubMed

Insights

Common medications like ibuprofen and acetaminophen can increase antibiotic resistance in gut bacteria. This study highlights the risk of non-antibiotic drug use in aged care facilities contributing to antimicrobial resistance (AMR).

Area of Science:

  • Microbiology
  • Pharmacology
  • Public Health

Background:

  • Antimicrobial resistance (AMR) is a significant global health threat, primarily driven by antibiotic overuse.
  • Non-antibiotic medications (NAMs) are increasingly recognized as potential contributors to AMR.
  • Residential aged care facilities (RACFs) frequently use both antibiotics and NAMs, necessitating investigation into their combined effects.

Purpose of the Study:

  • To investigate the potential of commonly used NAMs in RACFs to enhance antibiotic-induced mutagenesis.
  • To identify specific NAMs that contribute to the development of high-level antibiotic resistance.

Main Methods:

  • Exposure of Escherichia coli to gut-relevant concentrations of nine common NAMs (ibuprofen, diclofenac, acetaminophen, furosemide, metformin, atorvastatin, tramadol, temazepam, pseudoephedrine).
  • Assessment of mutagenesis and ciprofloxacin resistance.
  • Whole-genome sequencing to identify genetic mutations.
  • Analysis of drug efflux pump gene expression.

Main Results:

  • Ibuprofen and acetaminophen significantly increased mutation frequency and conferred high-level ciprofloxacin resistance in E. coli.
  • Whole-genome sequencing revealed mutations in GyrA, MarR, and AcrR genes.
  • Mutations in MarR and AcrR correlated with the overexpression of the AcrAB-TolC drug efflux pump.
  • Co-exposure to two NAMs further amplified mutation rates and resistance levels.

Conclusions:

  • Certain non-antibiotic medications, notably ibuprofen and acetaminophen, can promote antibiotic resistance.
  • The study identifies specific genetic mechanisms, including efflux pump upregulation, involved in NAM-mediated AMR.
  • Findings underscore the need to evaluate polypharmacy in aged care settings for potential AMR risks.

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