Gut Microbiota-Mediated Drug-Drug Interaction between Amoxicillin and Aspirin

Sci Rep. 2019 Nov 7;9(1):16194. doi: 10.1038/s41598-019-52632-5.


The effects of antibiotics on the intestinal flora can create potential drug-drug interactions. The combination of amoxicillin and aspirin is high and there is a high probability of interaction. We used 16S rRNA, incubation experiments and liquid chromatography-tandem mass spectrometry to analyze rat biological samples to characterize the effect of amoxicillin on the pharmacokinetics of aspirin metabolites. We first discovered that amoxicillin reduced the species and number of intestinal flora in rats, such as reducing the abundance of Helicobacter pylori and Prevotella_copri. After 12, 24, and 36 hours of incubation, the remaining amount of aspirin in the aspirin and amoxicillin treatment groups decreased, and salicylic acid production increased, suggesting that aspirin is metabolized by the intestinal flora, and the main metabolite is salicylic acid. As the incubation time prolonged, the reduction of aspirin and the production of salicylic acid in the amoxicillin treatment group were slower. It is indicated that the metabolic activity of aspirin through the intestinal flora is slowed down after administration of amoxicillin. The pharmacokinetic experiments showed that after administration of amoxicillin, the area under the salicylic acid curve increased by 91.38%, the peak concentration increased by 60.43%, and the clearance rate decreased by 43.55%.The results demonstrated that amoxicillin affected the pharmacokinetics of aspirin active metabolite salicylic acid by slowing down the metabolic activity of intestinal flora on aspirin. The interaction between amoxicillin and aspirin mediated by the intestinal flora may affect the efficacy of aspirin and cause more significant adverse effects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amoxicillin* / pharmacokinetics
  • Amoxicillin* / pharmacology
  • Animals
  • Aspirin* / pharmacokinetics
  • Aspirin* / pharmacology
  • Drug Interactions
  • Gastrointestinal Microbiome / drug effects*
  • Helicobacter pylori / metabolism*
  • Prevotella / metabolism*
  • Rats
  • Rats, Wistar


  • Amoxicillin
  • Aspirin

Supplementary concepts

  • Prevotella copri