Antibiotic use disrupts microbial composition and activity in humans, but whether this disruption in turn affects host metabolic health is unclear. Cohort studies show associations between antibiotic use and an increased risk of developing obesity and type 2 diabetes mellitus. Here, we review available clinical trials and show the disruptive effect of antibiotic use on the gut microbiome in humans, as well as its impact on bile acid metabolism and microbial metabolites such as short-chain fatty acids. Placebo-controlled human studies do not show a consistent effect of antibiotic use on body weight and insulin sensitivity at a population level, but rather an individual-specific or subgroup-specific response. This response to antibiotic use is affected by the resistance and resilience of the gut microbiome, factors that determine the extent of disruption and the speed of recovery afterwards. Nutritional strategies to improve the composition and functionality of the gut microbiome, as well as its recovery after antibiotic use (for instance, with prebiotics), require a personalized approach to increase their efficacy. Improved insights into key factors that influence the individual-specific response to antibiotics and dietary intervention may lead to better efficacy in reversing or preventing antibiotic-induced microbial dysbiosis as well as strategies for preventing cardiometabolic diseases.

抗生素的使用会破坏人类的微生物组成和活性，但这种破坏是否反过来影响宿主的代谢健康尚不清楚。队列研究表明抗生素的使用与肥胖和 2 型糖尿病风险增加之间存在关联。在这里，我们回顾了现有的临床试验，并展示了抗生素的使用对人类肠道微生物群的破坏性影响，及其对胆汁酸代谢和微生物代谢物（如短链脂肪酸）的影响。安慰剂对照的人体研究并未显示抗生素的使用对人群水平的体重和胰岛素敏感性具有一致的影响，而是显示个体特异性或亚组特异性的反应。这种对抗生素使用的反应受到肠道微生物组的抵抗力和恢复力的影响，这些因素决定了破坏程度和恢复速度。改善肠道微生物群的组成和功能以及使用抗生素（例如益生元）后的恢复的营养策略需要采取个性化的方法来提高其功效。更好地了解影响个体对抗生素和饮食干预的特异性反应的关键因素可能会在逆转或预防抗生素引起的微生物失调以及预防心脏代谢疾病的策略方面产生更好的功效。