Abstract: For a long time, due to the complexity of the gut microbial community and the lack of suitable culture methods and analytical techniques, the importance of gut microbiota in drug metabolism and disposition has not received enough attention. In recent years, with the rapid development of technology, extensive research on gut microbiota has brought our understanding of gut microbial metabolism and gut microbiota-host co-metabolism to an unprecedented height. Gut microbiota can not only directly metabolize many drugs, but also alter drug metabolism indirectly through complex and multidimensional interactions among the host, gut microbiota and drugs, thereby affecting individual response to drug treatment (efficacy, toxicity, resistance, etc.). Its structure and metabolic function are affected by many factors. This article reviews the latest advances and trends in the research on gut microbial drug metabolism with an aim to advance precision medicine and promote discovery of new drugs and new therapeutic strategies.