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Antimicrobial potentials and challenges of paracetamol: A comprehensive reassessment based on database reports

Muhammad Torequl Islam,R. Chowdhury,M. Bhuia,Md. Sakib Al Hasan,M. Akbor,Fardin Farhad,Carolina Bandeira Domiciano,Davi Antas e Silva,H. Coutinho

Published 2025 in Pharmaceutical Science Advances

ABSTRACT

Paracetamol (PMCL) is an analgesic-antipyretic drug. It is frequently used as an over-the-counter (OTC) drug in many countries around the world, especially for headaches, mild pain, and fever. Knowing its toxic effects on the nervous and hepatic systems, it has been combined with the psychoactive drug caffeine. However, PMCL's antipyretic action during fevers caused by various pathogens might be due to its antimicrobial power. Therefore, we have a question about whether PMCL can be used as an OTC medication or not. This review aimed to summarize the antimicrobial activity, facts behind it, possible action mechanisms, and causes of resistance growth, along with the antimicrobial and toxicological impacts of its metabolites, derived products, and combination products, on the basis of database reports. Numerous pieces of evidence suggest that both PMCL and caffeine have broad-spectrum antimicrobial effects. PMCL is evidently effective against gram-positive and gram-negative bacteria, fungi, viruses, and protozoa. Its major toxic metabolite, N-acetyl-p-benzoquinone imine (NAPQI), also has antimicrobial potential. Despite its antimicrobial effects, PMCL has contributed to antimicrobial resistance. In conclusion, according to the findings from database reports, PMCL is not only an analgesic-antipyretic drug, but it also has broad-spectrum antimicrobial potential against many pathogenic gram-positive and gram-negative bacteria and fungi as well as some viruses and protozoa. The use of PMCL as an OTC medication might bring a dangerous health issue in the future among the population, for example, growing microbial resistance and harmful toxicological impacts in different organs in humans.

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