Navigating microbial balance: Insights and interventions for optimal health amid antibiotic treatment in inflammatory bowel disease

The human microbiome, a diverse and dynamic community of microorganisms, plays fundamental roles in regulating host health by supporting digestion, nutrient absorption, and immune regulation. Disruptions in this microbial balance, refer to as dysbiosis can arise from factors such as dietary patterns, psychological stress, diseases states and use of medications, particularly antibiotics. Such dysbiosis have been associated with a wide range of conditions, including gastrointestinal disorders like inflammatory bowel disease (IBD), as well as systemic and neuropsychological complications. Antibiotics, while indispensable for the treatment of bacterial infections, may significantly alter microbial composition and diversity, potentially exacerbating dysbiosis in vulnerable populations such as individuals with IBD. These disruptions may reduce the production of beneficial metabolites, including short-chain fatty acids, and affect key microbial functions that contribute to anti-inflammatory processes and intestinal homeostasis. This review aims to examine the relationship between antibiotic-induced dysbiosis and metabolic and immune dysfunction in IBD, with a focus on its impact on gut barrier function and inflammatory pathways. Alterations in microbial abundance, such as an increase in harmful Proteobacteria and decrease in beneficial bacteria like Christensenellaceae, Coriobacteriaceae, Bacteroides, Suterella, Roseburia, Bifidobacterium, and Akkermansia muciniphila , are associated with IBD development. This imbalance impairs anti-inflammatory metabolites, various enzyme and metabolite production, leading to Ulcerative colitis (UC) and inflammation. This review further evaluates current and emerging strategies aimed at restoring microbial balance, including probiotics, prebiotics, fecal microbiota transplantation, dietary interventions, and antibiotic stewardship. Additional approaches such as lifestyle modifications, are also considered for their potential supportive roles. Despite growing evidence supporting microbiome-targeted therapies, important gaps remain in understanding strain-specific effects, long-term safety, and individualized treatment responses. Future research should prioritize well-designed clinical studies to clarify mechanisms and optimize therapeutic strategies for microbiome restoration in IBD.