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Microbial fingerprints can serve as biomarkers in determining responses to drugs.Drug metabolism by gut microbiome can alter efficacy and adverse effects of a drug.The plasticity of microbiome makes it a viable target for optimizing drug therapy.Fecal microbiota transplant allows identification of novel mechanisms.Microbe-derived therapeutics- pharmabiotics, compliment current treatment approaches.Gut microbiome is an integral part of the metabolic machinery that contributes to normal host function. The advent of next generation sequencing technologies has allowed an in-depth investigation of the microbiome at various body sites including microbes which are challenging to culture. The same technologies have revealed the metabolic capacity of the microbiome, identified novel microbial products and suggested possible implications for human health. The gut microbiome has previously not been considered in aspects of human health such as response to medications, which may be metabolized to a varying extent by the microbiome, thereby, altering their efficacy and the incidence of adverse events. Recent data suggest that the gut microbiome is an important factor to consider while evaluating inter-individual responses to medications. The gut microbiome is also a rich source of novel therapeutics — pharmabiotics, which can be harnessed to modify host function or alter the gut microbial ecosystem. We will highlight these aspects of the microbiome in this review.