Articles

Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Antimicrobial vs. Antibiotic: Which Is Best for Healing Your Gut?

Written by Dr. Michael Ruscio, DC on June 22, 2022

Written by Dr. Michael Ruscio, DC on June 22, 2022 — Reviewed by Aimee Gallo

How to Get Rid of Unhelpful Microorganisms and Improve Your Gut Health 

• Antimicrobial vs. Antibiotic: A Simple Distinction|
• Pharmaceutical or Herbal Antimicrobials?|
• Gut Conditions Tackled by Herbal Antimicrobials|
• How and When to Introduce Antimicrobials|
• Probiotics and Antibacterials Work Together|
• Bottom Line|

Antimicrobial vs. antibiotic — while these terms are sometimes used interchangeably there’s a difference between the two, which can have implications for healing poor gut health.

For example, H. pylori infections, which can cause stomach ulcers, are caused by just one specific bacteria and can be treated by one specific antibiotic. 

On the other hand, generalized gut dysbiosis may be caused by imbalances in many types of microorganisms (not just bacteria). In this case, a broad-spectrum antimicrobial agent may be a better treatment.

Antimicrobial vs. Antibiotic: A Simple Distinction

To hone in on the antimicrobial vs. antibiotic distinction more directly:

• An antimicrobial is anything that kills or prevents the growth of a living microorganism (microbe) [1].
• An antibiotic is a specific type of antimicrobial, used for fighting bacterial infections. It either kills bacteria (bactericidal) or inhibits them (bacteriostatic).

An antibiotic is always an antimicrobial, but an antimicrobial isn’t always an antibiotic.

Types of Antimicrobials

Broadly speaking, there are four main types of antimicrobials, each killing or inhibiting the growth of a different kind of microorganism [1]:

• Antibiotics, such as penicillin (antibacterials), kill bacteria such as staphylococcus aureus, E. coli, and so on
• Antivirals target viruses 
• Antifungals target fungi and yeasts
• Antiprotozoals target parasites (protozoa)

Some antimicrobials can have broad-spectrum actions. For example, just one herb can kill a range of bacteria, fungi, and protozoa [2].

Sanitizers and disinfectants are other names given to antimicrobials that kill a range of microbes, in this case usually on physical contact (for example when sprayed onto kitchen surfaces).

Pharmaceutical or Herbal Antimicrobials?

Distinguishing antimicrobial vs. antibiotic isn’t the only thing to think about. You’ll also need to consider if a pharmaceutical or more natural approach is better for you.

Functional medicine practitioners don’t generally like using conventional antibiotic drugs because they tend to be more aggressive in their effects and have a higher potential to cause antibacterial or antibiotic resistance.

I take the view that as long as they’re not overused, pharmaceuticals may sometimes be the right option for specific bacterial infections, overgrowths, or infectious diseases. For example, these can be legitimate uses of antibiotics:

• Rifaximin or rifaximin with neomycin for SIBO (small intestinal bacterial overgrowth) [3, 4]
• Fluconazole as an inhibitor of fungal infections [5]
• Flagyl to help eradicate protozoa [6]
• Amoxicillin for H. pylori [7]

Pharmaceuticals can be very effective. However, if you can achieve good relief with herbal antimicrobials this is usually better because [8]:

• Herbs have a broad-acting pharmacology, enabling control of drug-resistant bacteria. 
• Herbs don’t tend to contribute to the public health problem of resistant bacteria in the same way as conventional drugs. (Antimicrobial resistance occurs when bacteria develop mutations that mean they can escape being knocked out by antimicrobial drugs.)
• You’re likely to get fewer side effects [2, 8].

Gut Conditions Tackled by Herbal Antimicrobials 

Herbal antimicrobials haven’t been thoroughly tested in too many human diseases yet. However, below are details of four gut health conditions where the research is already quite convincing.

Other Benefits of Herbal Antimicrobials

Another advantage to using plant-based antimicrobials is that they may have extra positive effects, beyond killing harmful microorganisms in the gut.

Here are some wider benefits of antimicrobial agent benefits, supported by research: 

• Improved cognitive function: A systematic review found that berberine may help inhibit the development of dementia by preventing brain damage and enhancing cognition [16].
• Better mental stamina: Consuming peppermint oil helped people perform better and tire less quickly when given a mentally demanding task [17].
• Decreased inflammation: A high-quality research review found that supplementing with berberine was correlated with a reduction in a marker of inflammation (C-reactive protein) in the blood — indicating a reduction in chronic inflammation [18].

How and When to Introduce Antimicrobials

Let’s imagine you have troublesome gut-related symptoms, which can vary from bloating, IBS, Crohn’s, and colitis, to food sensitivities, fatigue, and brain fog. 

Given some of the evidence you’ve read above, herbal antimicrobials may sound like the treatment you’d want to opt for right away. However, I actually don’t recommend them as a first step for alleviating chronic gut health issues. 

Instead, the science points to sorting out your diet as a first priority, with probiotics as a secondary step. Antimicrobials are a treatment option to consider only after these two foundational steps.

Globally, good practice guidelines for IBS are also in support of this treatment pathway. For example, the 2021 IBS treatment guidelines from the British Society of Gastroenterology and Romanian Society of Neurogastroenterology suggest tackling diet first, administering probiotics second, and using antimicrobials third [19, 20].

Let’s look at the two steps you should take before considering antimicrobials. 

These are:

1. Eat healthily and make diet improvements that will help reset your gut health in a positive way.
2. Supplement with high-quality probiotics to help support your ongoing gut health.

Resetting the Gut With Healthy Diet

A healthy diet is so fundamental because it can reduce gut inflammation, which in turn can resolve imbalances in gut bacteria [21, 22].

I recommend starting with a Paleo diet, which removes or minimizes many potentially inflammatory foods such as gluten, dairy, chemical additives, and sugar. The Paleo diet has been shown to reduce inflammation by minimizing exposure to foods that may provoke an immune response [23].

However, if your gut issues are more entrenched, and you don’t see an improvement after a few weeks, a diet that eliminates a wider variety of troublesome foods may be needed, such as a low FODMAP diet.

It can take a few weeks to find a diet you’re happy with and enjoy that makes you feel healthier. At any point along this journey, you can also consider adding probiotics for more gut support.

Supporting Gut Health With Probiotics

Probiotics can help support your gut health by balancing out the gut microbiome. 

• One study found probiotics to be more successful than the antibiotic metronidazole in treating SIBO.
• Probiotics support a healthy immune response in the gut, as well as reduce gut inflammation [24, 25, 26, 27].
• Some research shows that probiotics may help prevent or treat viral infections, such as upper respiratory tract infections [28].

A simple three-step guide for adding probiotics to your regimen is as follows:

1. Take a quality blend of probiotics rather than just one type. At the Ruscio Institute for Functional Medicine clinic we’ve found a mix of three types — a Lactobacillus/Bifidobacterium blend, Saccharomyces boulardii (a friendly yeast), and a soil-based probiotic — to be particularly helpful
2. Monitor your symptoms for a month or so and notice when any improvements start to plateau.
3. Assuming you’ve achieved good benefits, you can start to taper down the amount of probiotics you take. Your aim is to find, and stay, on the minimum effective dose.

Moving Onto Antimicrobials

If you’re still getting some stubborn gut symptoms after making changes to your diet and taking probiotics, this is the point at which antimicrobials can be introduced. 

For many people a herbal or plant-based antimicrobial product will effectively knock out any remaining pathogens that are contributing to ongoing symptoms. A broad-spectrum supplement is a good choice. You may also want to rotate the antimicrobials you use over time, as this has been shown effective in conditions such as SIBO [29].

When weighing herbal antimicrobials vs. antibiotics of the conventional type, remember pharmaceuticals can sometimes still win. It’s something you should discuss with a trusted health professional to find what’s right for you.

Antibiotics are usually a short course, but herbal antimicrobials are most often taken over a longer period of time (a few months). 

Probiotics and Antibacterials Work Together

You may have heard that probiotics and antibiotics don’t mix, but this isn’t true.

Research is actually supportive of antibacterials/antibiotics being taken together with probiotics. For example: 

• Probiotics and antibiotics used together to treat SIBO increased the effectiveness of treatment [30]. In one study, the two together were doubly effective compared with an antibiotic on its own [31].
• In people with H. pylori, those who took probiotics and antibiotics together had better results than taking only antibiotics [32].

That said, it’s probably good practice to take these two categories of gut supplements at different times of day. You don’t want to give antimicrobials a chance to knock out the probiotics you’re taking.

Antimicrobial vs. Antibiotic: A Recap

Substances that kill a broad spectrum of microbes are antimicrobials, while those that only kill bacteria are antibiotics.

Broad spectrum, plant-based (herbal) antibacterials can be particularly helpful when it comes to ridding the gut of various unhelpful bacteria, viruses, and parasites that may slow your return to good health.

However, you don’t necessarily want to take antimicrobials straight away — try an anti-inflammatory diet and probiotics first, only introducing the antimicrobial supplement if you still have symptoms. 

If you need help weighing the various antimicrobial vs. antibiotic agents, or with gut or wider health issues in general, you can schedule an appointment with one of our functional health practitioners, or read my book, Healthy Gut, Healthy You, for more guidance.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.