The role of intestinal microflora in the formation of the methylthio adduct metabolites of paracetamol. Studies in neomycin-pretreated and germ-free mice

The contribution of the gastrointestinal microflora to the formation of methylthio adducts from paracetamol has been studied by comparing the fate of this drug in conventional mice with that in germ-free and neomycin-treated animals. In both germ-free and neomycin-treated mice there was a highly significant reduction in the urinary excretion of 3-methylthioparacetamol, its glucuronic acid and sulfate conjugates and its sulfoxide, with no other systemic alteration to the overall fate of the drug. These data are consistent with the gut flora playing a major role in the C-S cleavage of paracetamol-3-cysteine, thereby reducing the excretion of the array of methylthio adducts subsequently formed by tissue enzymes from 3-thioparacetamol, the putative product of the C-S cleavage.