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. R’s Fast Facts

Should you take probiotics along with antibiotics?

  • Co-administration of probiotics along with antibiotics or antimicrobial herbs increases the success rate of treatment.
  • In this study, the addition of a certain probiotic, Saccharomyces boulardii, to the treatment of H. pylori significantly increases the eradication rate of the H. pylori.
    • Also found true in other infections and even SIBO.

Should you take probiotics after antibiotics to reseed or repopulate the gut?

  • Probiotics do not colonize you. They have a transient benefit.
  • Studies show that weeks after taking a probiotic, evidence of that probiotic disappears from the stool.
  • Your microbiota is resistant to re-colonization or colonization by new stuff coming in from the outside.
  • You don’t have to worry about reseeding or repopulating after antimicrobial or antibiotic therapy.

Probiotics do have a very beneficial transient effect

  • To maintain the benefit, you may have to use probiotics on and off to maintain a long-term benefit.
  • 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.

If you are treating an infection, probiotics may have a nice benefit used synergistically.

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Taking Probiotics with Antibiotics or Antimicrobial Herbs

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

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

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

58 thoughts on “Taking Probiotics with Antibiotics or Anti-microbial Herbs

  1. Is it necessary to take probiotics on a daily basis since they don’t reseed themselves? Or should we change up from one probiotics to another?

  2. This completely confuses me. Does this mean that antibiotics won’t wipe away the whole of your gut microbiome? What is “your” microbiota? How did it get there in the first place if not by things we ingest (and mama, etc) and does this mean it never changes?

    If a person always has a microbiota, then why are antibiotics so detrimental? Do they or do they not wipe away the whole of the gut flora?

    If a person’s microbiota is resistant to repopulation, why do pathogenic infections persist? Why is there ever a need for antibiotics at all?

    And, what if a person’s microbiota includes bad bugs, such as someone who got sick early on, perhaps an autistic child, and then lives with that microbiota for the next 20 years? Does that mean their microbiota includes pathogenic microbes and if so they are stuck with them forever?

    These are completely confusing and contradictory concepts. I do not understand at all what the point of antibiotics or probiotics ever is if nothing new, good or bad, can ever be repopulated or integrated into an existing micro biome. Could you please clarify?

    1. These are great questions. The ebook on the microbiota should provide you a nice, clear answer to all of these. It should be available in 2 months 🙂 Hang in their until then.

  3. Thanks for this informative explanation, as I have also wondered about these questions. I am curious to know how PRE-biotics fit into this scenerio. Do they also help make antibiotic treatments more effective and/or even more effective than taking probiotics? And do probiotics that contain pre-biotics reseed the gut after antibiotics? What are your thoughts on this? probiotics v. prebiotics? Thanks!

    1. Hi Emily,

      We have less data on prebiotics in this regard. There is one SIBO study that showed prebios co-administered with Rifaximin enhanced results. My thinking is probiotics would have the best synergistic effect. Reseeding doesn’t really occur, I will expand on this in the ebook. Its still a good idea to use pro/pre bios, but to think they reseed is a misnomer. Ebook will help illustrate the utility of each probios vs perbios, its not a super short answer, sorry! Hope this helps!

      1. Thanks so much for your reply! I am wondering if you could share a link to the study regarding SIBO and prebiotics? I am treating for SIBO now and would love to be able to share this with my Naturopath, as she is recommending probiotics following treatment, yet now I am thinking it best to take them during treatment. Thanks again! Your info and videos are super helpful!

  4. Thanks for this informative explanation, as I have also wondered about these questions. I am curious to know how PRE-biotics fit into this scenerio. Do they also help make antibiotic treatments more effective and/or even more effective than taking probiotics? And do probiotics that contain pre-biotics reseed the gut after antibiotics? What are your thoughts on this? probiotics v. prebiotics? Thanks!

    1. Hi Emily,

      We have less data on prebiotics in this regard. There is one SIBO study that showed prebios co-administered with Rifaximin enhanced results. My thinking is probiotics would have the best synergistic effect. Reseeding doesn’t really occur, I will expand on this in the ebook. Its still a good idea to use pro/pre bios, but to think they reseed is a misnomer. Ebook will help illustrate the utility of each probios vs perbios, its not a super short answer, sorry! Hope this helps!

      1. Thanks so much for your reply! I am wondering if you could share a link to the study regarding SIBO and prebiotics? I am treating for SIBO now and would love to be able to share this with my Naturopath, as she is recommending probiotics following treatment, yet now I am thinking it best to take them during treatment. Thanks again! Your info and videos are super helpful!

  5. Looking forward to your podcast on H pylori. Up to now my main source of info has been helico.com. If possible, please weigh in during the podcast on (1) pepto bismol tablets (2) SOB probiotics (prescript-assist, mega sporebiotic etc).—is the research really there specifically for H pylori? (3) zinc/carnosine supplement based on a Japanese prescription drug discussed in “Natural Support for Stomach Health” Life Extension Magazine October 2015

    Thank you for your time and consideration on these topics!
    BJ

  6. Looking forward to your podcast on H pylori. Up to now my main source of info has been helico.com. If possible, please weigh in during the podcast on (1) pepto bismol tablets (2) SOB probiotics (prescript-assist, mega sporebiotic etc).—is the research really there specifically for H pylori? (3) zinc/carnosine supplement based on a Japanese prescription drug discussed in “Natural Support for Stomach Health” Life Extension Magazine October 2015

    Thank you for your time and consideration on these topics!
    BJ

  7. Thanks for this information! If probiotics don’t actually colonize the gut more permanently, how does one re-populate an unhealthy gut with good bacteria? Is this where yogurt, kefir, and cultured vegetables might be more effective? Does good bacteria from those foods stay in the gut for a while?

  8. Thanks for this information! If probiotics don’t actually colonize the gut more permanently, how does one re-populate an unhealthy gut with good bacteria? Is this where yogurt, kefir, and cultured vegetables might be more effective? Does good bacteria from those foods stay in the gut for a while?

  9. Thank you for answering my question about taking my Saccharomyces boulardii, along with the antibiotic amoxicillin for a tooth infection. I might need another dose of antibiotic so should I continue it along with the Saccharomyces boulardii again?

      1. Will Nystatin kill S. Boulardi? I was under the impression it does. Dr. Ruscio are you able to help people where the candida overgrowth has spread to the point its out in the tissues? I am so miserable. I am irritable, angry, sick. I can’t get near the cheese department, near anyone that has had alcohol or vinegar. It has spread to the point I feel it out in the tissues and I taste metal in my mouth. I did the smart pill procedure yesterday and had to eat a piece of gluten free toast with jam on it. I am so miserable. The fungus grew. No one can seem to repopulate the gut effectively because the candida spread long ago and I believe hyphal. Do you have suggestions? To see you is 6 months from now…not sure if I am going to be able to live that long. This is a sad example of how Western medicine doesn’t understand the gut microbiome. I wish someone could help me. I take Diflucan, Nystatin, herbal products, glutathione, miconazol (anus and vulvar area). Thank you for any help you can offer me at this point.

        1. Also, I was diagnosed in 12/08 with Methane SIBO and was never corrected and the candida which already existed and was being fed by the things I drank and ate took off.

          1. I have been given many antibiotics over the course of my life with no probiotics. Clindamycin, Cipro, Tetracycline, Amoxicillin, one for kidney infection, others for mitral valve prolapse…one for CMV, CFS and EBV…I am a real sick mess.

          2. Hi Marjorie,

            I’m so sorry to hear you’ve been dealing with this for so long. Your best bet is to contact the office and they can give you more information about working with Dr Ruscio. You can call or you can get in touch here: https://www.drruscio.com/gethelp

            Regarding s. boulardii, it’s probably best to take it a couple hours away from nystatin just to be safe.

  10. I was diagnosed with Hpylori back in 2015 and was treated for it. I was just diagnosed with Sibo with breath test, and my Hydroden level is high. I am unable to get Riflaxin due to insurance and was given Ciprofloxacin.
    I was wondering if I should take a probiotic during the 14 day treatment or after. I was taking Align but I think I need something stronger. Can you recommend a probiotic.

    Thanks

    1. I’m in the exact same boat as you. How did Cipro work for you? Did you ever eradicate SIBO for good? If so what was the strength and length of time on Cipro? I have a 500mg 2 week dose but am afraid to take them for IBS-D/SiBO

  11. I was diagnosed with Hpylori back in 2015 and was treated for it. I was just diagnosed with Sibo with breath test, and my Hydroden level is high. I am unable to get Riflaxin due to insurance and was given Ciprofloxacin.
    I was wondering if I should take a probiotic during the 14 day treatment or after. I was taking Align but I think I need something stronger. Can you recommend a probiotic.

    Thanks

    1. I’m in the exact same boat as you. How did Cipro work for you? Did you ever eradicate SIBO for good? If so what was the strength and length of time on Cipro? I have a 500mg 2 week dose but am afraid to take them for IBS-D/SiBO

  12. Should Itake laxatives with rifaxan as the last I took rifaxan,I ellininated beautiful ly and now I am not at all. Also should I talked Align with this as I have been given it by the dr.

  13. Should Itake laxatives with rifaxan as the last I took rifaxan,I ellininated beautiful ly and now I am not at all. Also should I talked Align with this as I have been given it by the dr.

  14. This completely confuses me. Does this mean that antibiotics won’t wipe away the whole of your gut microbiome? What is “your” microbiota? How did it get there in the first place if not by things we ingest (and mama, etc) and does this mean it never changes?

    If a person always has a microbiota, then why are antibiotics so detrimental? Do they or do they not wipe away the whole of the gut flora?

    If a person’s microbiota is resistant to repopulation, why do pathogenic infections persist? Why is there ever a need for antibiotics at all?

    And, what if a person’s microbiota includes bad bugs, such as someone who got sick early on, perhaps an autistic child, and then lives with that microbiota for the next 20 years? Does that mean their microbiota includes pathogenic microbes and if so they are stuck with them forever?

    These are completely confusing and contradictory concepts. I do not understand at all what the point of antibiotics or probiotics ever is if nothing new, good or bad, can ever be repopulated or integrated into an existing micro biome. Could you please clarify?

    1. These are great questions. The ebook on the microbiota should provide you a nice, clear answer to all of these. It should be available in 2 months 🙂 Hang in their until then.

  15. Is it necessary to take probiotics on a daily basis since they don’t reseed themselves? Or should we change up from one probiotics to another?

  16. Thank you for answering my question about taking my Saccharomyces boulardii, along with the antibiotic amoxicillin for a tooth infection. I might need another dose of antibiotic so should I continue it along with the Saccharomyces boulardii again?

      1. Will Nystatin kill S. Boulardi? I was under the impression it does. Dr. Ruscio are you able to help people where the candida overgrowth has spread to the point its out in the tissues? I am so miserable. I am irritable, angry, sick. I can’t get near the cheese department, near anyone that has had alcohol or vinegar. It has spread to the point I feel it out in the tissues and I taste metal in my mouth. I did the smart pill procedure yesterday and had to eat a piece of gluten free toast with jam on it. I am so miserable. The fungus grew. No one can seem to repopulate the gut effectively because the candida spread long ago and I believe hyphal. Do you have suggestions? To see you is 6 months from now…not sure if I am going to be able to live that long. This is a sad example of how Western medicine doesn’t understand the gut microbiome. I wish someone could help me. I take Diflucan, Nystatin, herbal products, glutathione, miconazol (anus and vulvar area). Thank you for any help you can offer me at this point.

        1. Also, I was diagnosed in 12/08 with Methane SIBO and was never corrected and the candida which already existed and was being fed by the things I drank and ate took off.

          1. I have been given many antibiotics over the course of my life with no probiotics. Clindamycin, Cipro, Tetracycline, Amoxicillin, one for kidney infection, others for mitral valve prolapse…one for CMV, CFS and EBV…I am a real sick mess.

          2. Hi Marjorie,

            I’m so sorry to hear you’ve been dealing with this for so long. Your best bet is to contact the office and they can give you more information about working with Dr Ruscio. You can call or you can get in touch here: https://www.drruscio.com/gethelp

            Regarding s. boulardii, it’s probably best to take it a couple hours away from nystatin just to be safe.

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