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Can You Take Probiotics With Antibiotics? Yes, Here’s How

Written by Dr. Michael Ruscio, DC on December 30, 2024

Written by Dr. Michael Ruscio, DC on December 30, 2024 — Reviewed by Dr. Hannah Hamlin

• Combination Therapy|
• Antibiotic Side Effects|
• Best Treatment Approach|

If you need to take an antibiotic to clear an infection, you may be wondering, “Can you take probiotics with antibiotics?” The answer is a resounding yes! 

But I’ve seen some healthcare providers warn people against taking probiotics along with their antibiotic therapy. Where is this advice coming from?

It may come from single small studies, such as one that questioned the value of taking probiotics and antibiotics together 1. 

In this study of 21 patients, eight of them received probiotic therapy, seven received no treatment, and six received a fecal transplant. 

The researchers found that the probiotics were less effective for antibiotic recovery than no treatment at all. In contrast, the fecal transplant brought nearly complete recovery in a matter of days.

These results may seem like a good reason to avoid taking probiotics with antibiotics. But when looking for health insights from research, it’s important to follow the overall trends rather than focusing on just one study. 

Before getting into the best probiotic approach, I’d like to share the research on how adding probiotics to antibiotic treatment can work in your favor.

Can Probiotics Make Antibiotics More Effective?

Some people believe it’s pointless to take probiotics and antibiotics together because the antibiotics will “kill all the good bacteria.” That may sound logical, but research tells a different story. 

In fact, antibiotics don’t cancel out the beneficial effects of probiotics at all. Research shows the two can work together to enhance the antibiotic treatment of a range of bacterial infections.

Probiotics and Helicobacter Pylori Infection

People who take probiotics and antibiotics together for an H. pylori infection typically have better results than those who take antibiotics only 2. Adding probiotics to antibiotics can increase the success rate of getting rid of H. pylori by about 10% 3.

These benefits might happen because probiotics can make harmful bacteria more sensitive to antibiotics. For example, adding the probiotic yeast Saccharomyces boulardii to antibiotic treatment for H. pylori can reduce the activity of bacterial genes that cause antibiotic resistance 4.

Probiotics and Small Intestinal Bacterial Overgrowth (SIBO)

Taking probiotics with antibiotics for SIBO can make treatment more effective than taking antibiotics alone. For example,

• Using S. boulardii together with the antibiotic metronidazole may be more than twice as effective at clearing SIBO compared to using metronidazole alone 5.
• Combining probiotics and antibiotics may clear SIBO in almost 9 out of 10 people with SIBO and Crohn’s disease 6.

Additionally, probiotics may be the key to overcoming hydrogen sulfide SIBO, especially in people who haven’t responded to antibiotics 7.

Probiotics and Clostridium Difficile Infections 

Probiotics are also promising for people with serious Clostridium difficile infections, which are often caused by taking too many antibiotics 8.

C. difficile is a tenacious bacterium that takes advantage of disruptions in the gut microbiota. It can be very difficult to eradicate and can lead to life-threatening diarrhea and colon inflammation 8.

Probiotics can safely prevent C. difficile infections in both adults and kids 9 10. They may also be able to help get rid of an active C. diff infection 11.

Probiotics and Genital Infections

Probiotics are effective at curing and preventing bacterial vaginosis (an overgrowth of bacteria in the vagina), especially when taken with antibiotics 12.

And in men with infections of the genital tract, probiotics added to antibiotics can be much more effective at clearing the infection than antibiotics alone 13. 

Can Probiotics Prevent Antibiotic Side Effects?

Probiotics can both combat antibiotic side effects and restore balance to the gut microbiome, according to high-quality research. 

Antibiotics work by killing harmful bacteria that cause infections. Most antibiotics are broad-spectrum, meaning they kill many types of bacteria, whether they’re helpful, neutral, or harmful. Some broad-spectrum antibiotics, like amoxicillin, ciprofloxacin, and cefprozil, can alter the gut microbiome for up to 12 weeks 8. 

When we take antibiotics, they get rid of the invaders (harmful bacteria), but they also kill healthy gut flora in the process. Losing beneficial bacteria during antibiotic treatment can cause dysbiosis (microbial imbalance) and its downstream effects, including 14 15:

• Infections from viruses, “bad bacteria”, and fungi
• Inflammation
• An overloaded immune system 

So, when we take an antibiotic, especially for a longer length of time or repeated rounds, we may experience some unpleasant side effects, such as diarrhea, a yeast infection, or gastrointestinal pain or bloating.

Probiotics and Dysbiosis 

Dysbiosis, a common negative effect of using antibiotics, impairs normal gut function and allows harmful bacteria to increase rapidly.

Adding probiotics, such as Lactobacillus species, Bifidobacterium species, and S. boulardii, during antibiotic treatment can help maintain a healthy balance of gut microorganisms and support the recovery of beneficial microbes 16.

In fact, a review of studies showed that about 8 of 10 (83% of) healthy people who took antibiotics showed recovery of their gut bacteria when they also took probiotics 17. 

Probiotics and Antibiotic-Associated Diarrhea

Diarrhea is one of the most common side effects of antibiotic use, and it’s generally caused by dysbiosis. Probiotics are a great tool to help prevent antibiotic-associated diarrhea in people of all ages 18 19.

Taking probiotics with antibiotics may reduce the risk of antibiotic-associated diarrhea in adults by more than a third (37%). High doses of probiotics may be even more effective, possibly reducing the risk by almost half (46%) 20.

Higher doses of probiotics can also prevent antibiotic-associated diarrhea or reduce its duration in children by a whole day 21.

The earlier probiotics are added to antibiotics, the better. Studies have shown that:

• Starting probiotics within 24 hours of starting antibiotic treatment can reduce the risk of diarrhea by 35% in pediatric patients 18.
• Starting probiotics within 48 hours of starting antibiotics can reduce antibiotic-associated diarrhea by 29% in elderly people 19.

Unfortunately, starting probiotics after 48 hours of beginning antibiotic therapy may not prevent diarrhea 19. But it’s still a good idea to start probiotics later in antibiotic treatment because  they can help restore balance in the gut microbiome and help the antibiotics do a good job.

How to Take Probiotics With Antibiotics

For my clients who need to take antibiotics, I advise them to add probiotics as soon as they start taking antibiotics. 

It might even be better to start probiotics before a course of antibiotics and continue them for a while after the antibiotic therapy is complete. I think of this approach like priming the pump to help keep antibiotic side effects like diarrhea at bay and giving the gut microbiome a better chance of recovering 22.

What’s the Best Probiotic To Take With Antibiotics?

Most probiotic products fit into one of three categories:

• Lactobacillus/Bifidobacterium blends
• Saccharomyces boulardii
• Soil-based species (Bacillus species)

All of these have shown benefit when used alongside antibiotics, so there’s no need to go strain shopping 23. This is because all probiotics tend to have the same health benefits, such as 24:

• Balancing the gut microbiota
• Regulating the immune system
• Reducing inflammation
• Fighting infectious organisms
• Reducing leaky gut

Most research trials use a blend of probiotic strains, and that approach works well for us in the clinic. We encourage our clients to use what we call probiotic triple therapy, which is simply using all three categories together. 

When Should You Take Probiotics?

Some would recommend taking probiotics at least two hours before or after antibiotics to maximize the benefit.

It’s ok to do this, but if that makes the medication schedule too complicated, we just have our clients take them at the same time of day. It’s better to take probiotics and antibiotics together than to not take them at all. 

What About Probiotic Foods?

The diet is another way to add probiotic bacteria to the gut. A number of fermented foods, such as kefir, kimchi, kombucha, lacto-fermented sauerkraut, and many types of yogurt, are rich in healthy bacteria. 

However, as this table shows, it may be difficult to eat enough fermented foods to get the range of species and the therapeutic dose you’ll find in a probiotic supplement.

Eating fermented foods on a regular basis, if you tolerate them, is a great way to sneak in some probiotics to support your healthy gut bacteria. But it may not be enough to recover the damage from antibiotics. For this reason, I recommend adding a quality probiotic supplement.

Probiotics Can (And Should) Be Taken With Antibiotics

Can you take probiotics with antibiotics? Absolutely! Taking probiotics can be a simple, effective way to make antibiotics more effective, support gut health and wellness, and significantly reduce the adverse effects of antibiotics, such as diarrhea and gut dysbiosis. 

Although some people recommend against the use of probiotics until after an antibiotic course is complete, research does not support this approach. 

In our experience in the clinic, people tend to get the best results when they start multi-strain probiotics before or at the same time as antibiotic therapy starts. You don’t need to worry about which single strains of probiotics to use or what time of day to take them.

If you’ve been taking antibiotics for a long time, it may be helpful to try the Great-In-8 gut healing action plan in my book, Healthy Gut, Healthy You, or reach out to us at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our clients 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. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.