Taking Probiotics with Antibiotics or Anti-microbial Herbs

Should you take probiotics while being treated with antibiotics or antimicrobial herbs? Or should you take probiotics after treatment to “reseed” or “repopulate” the gut? Let’s dispel a few common misconceptions around these two questions.

Dr. Michael Ruscio, DC: Should you take probiotics along with antibiotics?

Hi. This is Dr. Ruscio, DC, and a common question or concern that my patients have is regarding probiotics and how to use them if they’re taking antibiotics or herbal antimicrobials. Oftentimes what patients ask me is, “Shouldn’t I wait to take a probiotic until after I have taken an antibiotic or an herbal antimicrobial because the antibiotic or the herb will just kill the probiotic?” This is actually not correct, and there are a few reasons for this.

Now, probably the most clinically relevant is that when we co-administer probiotics along with antibiotics or antimicrobial herbs, it increases the success rate of treatment, and I will put up on the screen here and also include a link to a systemic review with meta-analysis that has shown that the addition of a certain probiotic, Saccharomyces boulardii, to the treatment of H. pylori significantly increases the eradication rate of the H. pylori. This sort of finding has been found in other infections or even things like SIBO also. Probiotic co-administration with treatment tends to enhance treatment results. That is the most important reason why.

Another question that patients often have is, “After taking an antibiotic or antimicrobial, should I take a probiotic to reseed or to repopulate the gut?” This is also wrong. Probiotics do not colonize you. They have a transient benefit. This has been shown in numerous studies, that after taking a probiotic, weeks after taking a probiotic, any evidence of that probiotic disappears from the stool. The reason for this is actually a good one. It’s because your microbiota, the world of bacteria, fungus, and viruses and protozoa that inhabit your intestines in a healthy way—that colony is resistant to re-colonization or colonization by new stuff coming in. So it’s good from the perspective of if you swallow a bad bacteria, all of the current players in the gut want to prevent this guy from settling in. So the gut is resistant to colonization by stuff that we swallow. This includes probiotics. Now, probiotics do have a very beneficial transient effect, so we certainly want to use probiotics. It’s not to say that we don’t want to use them. But to maintain the benefit, you’ll probably have to use them at least on and off to maintain a long-term benefit from a probiotic. It is possible that after a short course of probiotic you may fix the underlying problem and you may not need it in the long term, but the probiotic will not colonize you.

These are some important things for people to keep in mind, that taking a probiotic with antimicrobial or antibiotic treatment will likely enhance the results as long as your clinician knows what probiotics to use with what infections, and that probiotics don’t re-colonize you because your microbiota is resistant to colonization from outside stuff, if you will.

So, remember, if you are treating an infection, probiotics may have a nice benefit used synergistically, and probiotics, again, do not re-colonize you, and so you don’t have to worry about reseeding or repopulating after antimicrobial or antibiotic therapy. It’s still a great idea to use probiotics, but just understand that the probiotics are not going to colonize you or reseed or repopulate.

Anyway, this is Dr. Ruscio, DC, and I hope this helps you get healthy and get back to your life. Thanks.