New Delhi, 27 August 2025: A recent study published in npj Antimicrobials and Resistance reveals that common painkillers like ibuprofen (Advil) and paracetamol (Tylenol) may inadvertently accelerate the rise of antibiotic-resistant bacteria—raising fresh concerns about the intertwined threats of misuse and microbial evolution.
Surprising Findings: Painkillers as Resistance Amplifiers
Researchers from the University of South Australia conducted experiments on Escherichia coli, a bacterium commonly responsible for gut and urinary tract infections. When exposed to ciprofloxacin—an antibiotic—alongside ibuprofen or paracetamol, the bacteria showed elevated mutation rates, rapidly developing resistance not only to ciprofloxacin but also to multiple drug classes. This contrasts sharply with bacteria exposed to the antibiotic alone, which remained more vulnerable.
Lead researcher Professor Rietie Venter commented that this new evidence underlines how antibiotic resistance arises from more than just misuse of antibiotics. “It’s not just about antibiotics anymore,” Venter said, urging a broader perspective on medication interactions.
Implications for Public Health and Care
The findings are particularly relevant for vulnerable groups, such as elderly patients in aged-care facilities, where polypharmacy is common. The study underscores the need for healthcare providers to reassess routine prescribing practices—especially combinations of antibiotics and over-the-counter painkillers.
Antimicrobial resistance (AMR) already claims more than 1.27 million lives annually, and projected estimates suggest this number could rise to 39 million by 2050 if current trends remain unchecked.
Underlying Mechanisms Revealed
Further laboratory research suggests these non-antibiotic drugs may activate bacterial defense mechanisms. For example, NSAIDs like ibuprofen can increase expression of efflux pumps—cellular mechanisms that eject antibiotics—particularly through the MarA and AcrB pathways.
Additionally, non-antibiotic pharmaceuticals such as NSAIDs are now linked to horizontal gene transfer (HGT)—a process that accelerates the sharing of resistance genes among bacteria. This highlights a dual threat: beyond drug-induced mutations, medications might be inadvertently helping bacteria share resistance more efficiently
Dr. Amandeep Singh, a clinical pharmacologist who reviewed the study, commented:
“This research is a wake-up call. Over-the-counter medications we consider benign—like ibuprofen and acetaminophen—can significantly affect the dynamics of antibiotic resistance when used alongside antibiotics. We need renewed stewardship, especially in long-term care settings.”
Recommendations for Patients and Providers
- Review medication regimens carefully, especially for elderly patients on multiple drugs.
- Avoid routine co-use of painkillers with antibiotics unless advised by a medical professional.
- Prioritize non-drug pain relief methods—such as ice, elevation, or physical therapy—when appropriate.
- Educate caregivers and providers about the hidden risks of polypharmacy and AMR.
This new study challenges conventional thinking: antibiotic resistance isn’t fueled solely by misuse of antibiotics but also by everyday drugs like painkillers. Addressing AMR requires a holistic medication strategy—one that considers drug interactions at every level.
