The Truth About Taking Probiotics With Antibiotics

The Truth About Taking Probiotics With Antibiotics

The Surprising Benefits of Combined Therapy

If you leave your doctor’s office with a prescription for antibiotics, you may have very mixed feelings. Of course, you want to clear up an infection, but at what cost to the beneficial bacteria in your gut microbiome? In order to reduce damage to the gut, should you be taking probiotics with antibiotics?

In the story of modern medicine, antibiotics play the role of both hero and villain. Few other drugs have saved so many lives. However, antibiotics also play a part in the growing epidemic of gut dysbiosis, antibiotic resistance, and the litany of chronic health conditions that result from poor gut health.

Taking probiotics with antibiotics: pill bottle with a question mark on it

So, if you must take a course of antibiotics, taking probiotics with antibiotics  is a great way to combat negative side effects. Plus, they have lots of other health benefits.

Some people suggest that it’s pointless to take probiotics and antibiotics together since the antibiotics will “kill all the good probiotic bacteria.” While that may make sense intuitively, recent studies show that probiotics and antibiotics actually work in partnership. 

In fact, adding a probiotic to your antibiotic protocol has been shown to significantly improve treatment outcomes for SIBO and H. Pylori. Probiotics can also help to reduce or resolve antibiotic-associated side effects including diarrhea. 

Let’s take a look at some of that research now. 

Yes, you SHOULD take probiotics and antibiotics at the same time!

✓ Taking probiotics and antibiotics together is more effective than taking antibiotics alone.

✓ Adding probiotics to an antibiotic protocol for SIBO can more than double the treatment success rate.

✓ Probiotics reduce antibiotic side effects, including antibiotic-associated diarrhea.

✓ Probiotics reduce the likelihood of C. difficile (c. diff) infections for patients on long-term antibiotic therapy.

Probiotics Make Antibiotics More Effective

Rather than canceling each other out, research shows that taking probiotics and antibiotics together is more effective than taking antibiotics alone.

One of the most relevant studies to show this effect is a systematic review of more than 20,000 patients with H. pylori infections [1 Trusted SourcePubMedGo to source]. Patients who took probiotics and antibiotics together had better results than patients who only took antibiotics. 

Another recent meta-analysis of randomized clinical trials totalling roughly 6,000 patients with H. pylori infections showed that adding probiotics to antibiotic therapy for H. pylori increased the eradication rate by about 10% [2 Trusted SourcePubMedGo to source].

Probiotics Make Antibiotic SIBO Treatment More Effective  

There is also research showing that probiotics and antibiotics are more effective together for small intestinal bacterial overgrowth (SIBO) treatment:

  • One study of 40 patients with SIBO showed those taking a combination of S. boulardii and metronidazole (an antibiotic) had more than double the success rate for eradicating SIBO with when compared to those taking metronidazole alone [3 Trusted SourcePubMedGo to source].
  • Another study showed that a combination of probiotic and antibiotic therapy normalized glucose breath tests for 13 out of 15 patients with both SIBO and Crohn’s disease [4 Trusted SourcePubMedGo to source].
  • Probiotics have been found to be a possible helpful addition to treatment in hydrogen SIBO, particularly in people who have not responded to antibiotics for treatment [5 Trusted SourcePubMedGo to source]. 

Overall, probiotic co-administration with antibiotics is a safe, non-invasive, and effective way to enhance treatment results.

Probiotics Reduce Antibiotic Side Effects

When you have been on antibiotics before, did you have adverse effects such as diarrhea, yeast infections, or gastrointestinal pain?

Antibiotics work by killing harmful bacteria that cause infections. Most antibiotics are broad-spectrum, meaning they kill a lot of different types of bugs. This broad action makes them useful for a lot of different types of infections, and it’s also why they can end up killing good bacteria too.

Antibiotic side effects are often caused by the loss of beneficial bacteria and resulting dysbiosis [6 Trusted SourcePubMedGo to source]. Dysbiosis can lead to:

Antibiotic side effects can be long-lasting, especially with repeated antibiotic treatments. Probiotics can be very helpful in restoring the healthy balance of gut bacteria. A large number of studies back this up. 

Let’s look at a few examples:

Probiotics Correct Dysbiosis Caused by Antibiotics

A systematic review of 63 trials examined all the available research into probiotic use for dysbiosis [8 Trusted SourcePubMedGo to source]. In healthy subjects who experienced a disturbance in their microbiota after antibiotic use, 83% of subjects experienced microbiota recovery after taking probiotics. 

Both Lactobacillus/Bifidobacterium probiotics and Saccharomyces boulardii were shown to be effective.

While more research needs to be done on preventing yeast infections specifically, probiotics are shown to generally recover the microbiome after antibiotic use. 

Probiotics Resolve Antibiotic-Associated Diarrhea

Taking probiotics with antibiotics: person holding a roll of toilet paper

Antibiotic-associated diarrhea is one of the most common side effects of antibiotic therapy. It’s caused by the dysbiosis that impairs normal gut function and allows harmful bacteria to proliferate.

A number of studies have found that probiotics work well to prevent and treat antibiotic-associated diarrhea. 

  • One study found that taking probiotics with antibiotics reduced the risk of antibiotic-associated diarrhea by 37% in adults. A high dose was even more effective at 46% reduced risk. Lactobacillus and Bifidobacteria probiotics were shown to be particularly helpful [9 Trusted SourcePubMedGo to source].
  • A 2019 study in children found that, in particular, higher doses of probiotics were effective at preventing diarrhea or reducing duration of diarrhea by one day in children who still got antibiotic-associated diarrhea [10 Trusted SourcePubMedGo to source].
  • When adding probiotics with antibiotics in treatment of H. pylori, the addition of probiotics for longer than 10 days reduced the incidence of gastrointestinal side effects such as diarrhea, vomiting/nausea, and abdominal pain [2 Trusted SourcePubMedGo to source].

Probiotics from all three categories of probiotics were used in these studies. These categories are Lactobacillus and Bifidobacterium blends, Saccharomyces boulardii, and soil-based Bacillus species [2 Trusted SourcePubMedGo to source, 9 Trusted SourcePubMedGo to source, 10 Trusted SourcePubMedGo to source, 11 Trusted SourcePubMedGo to source]. In other words, whichever type of probiotic you use is likely to provide benefits. 

Clostridium Difficile Infections

Researchers also see promising results when probiotics are used for serious Clostridium difficile infections.

C. difficile is a bacterial infection that takes advantage of disruptions in the microbiota and can be difficult to eradicate. C. diff infections can lead to life-threatening diarrhea and colon inflammation.

A meta-analysis of research involving close to 7,000 patients shows that probiotics are a useful and safe prevention strategy for C. difficile infections. Researchers recommend probiotics for patients taking two or more antibiotics and in hospital settings [12 Trusted SourcePubMedGo to source]. Similar recommendations have also been made for pediatric patients [13 Trusted SourcePubMedGo to source].

Is There a Case Against Taking Probiotics with Antibiotics?

Illustration of the intestines with virus

I’ve seen some internet articles that warn people against taking probiotics to help with recovery from 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 [14 Trusted SourcePubMedGo to source]. In this study of 21 patients, eight patients received probiotic therapy, seven patients received no treatment, and six patients received a fecal transplant. Researchers found that probiotics were less effective for antibiotic recovery than no treatment at all. The fecal transplant brought near-complete recovery in a matter of days.

However, when you are looking for health insights from research, it’s important to follow the overall trends rather than focus narrowly on one study. For example, let’s compare the evidence from that small, non-randomized study to a broad meta-analysis of many randomized controlled trials (RCTs), the gold standard type of research.

The large-scale meta-analysis of 63 RCTs showed that subjects had 48% less antibiotic-associated diarrhea after taking probiotics [11 Trusted SourcePubMedGo to source].

But that one single study involving fewer than 20 patients found probiotics to be less effective (for eight patients) than no treatment at all (for seven patients) [14 Trusted SourcePubMedGo to source].

It’s clear that one small, non-randomized study doesn’t stand up against a much larger meta-analysis of 63 gold standard RCTs. This is the reason the meta-analysis of RCTs is the highest quality type of research.

Bottom line: Be careful about science-based claims you read on the internet. Marketers often cherry-pick studies to support their position.

The Best Way to Combine Probiotics with Antibiotics

If you’re taking antibiotics, I highly recommend taking them with probiotics. In fact, researchers suggest that taking probiotics as early as possible with antibiotics is best for decreasing antibiotic side effects such as antibiotic-associated diarrhea [15 Trusted SourcePubMedGo to source, 16 Trusted SourcePubMedGo to source].

Here are some tips on how to get the most from your probiotic supplement when taking antibiotics.

Don’t Go Strain Shopping

You don’t need to find the one right probiotic strain for your specific health condition.

Many different types of probiotics have been shown to be beneficial when used alongside antibiotics. 

That’s because all probiotics have a similar effect of balancing the gut microbiota, modulating the immune system and reducing inflammation.

Lactobacillus/Bifidobacterium blends and Saccharomyces boulardii are the two categories of probiotics that are used most often in research. Soil-based probiotics are a third category of probiotics used in research, albeit less frequently. 

One very large meta-analysis compared results for 63 different studies and found no difference in results across the three probiotic categories for antibiotic associated diarrhea [11 Trusted SourcePubMedGo to source]. Most of the research trials used a blend of probiotic strains.

Choose a Quality Probiotic Formula

Quality assurance practices do matter. Probiotic manufacturing is not highly regulated and some label claims do not stand up to scrutiny. Consider the results of these investigations into probiotic quality:

  • One study assessed 26 commercial probiotics and found that none fully supported label claims. Some probiotic supplements contained unacceptable microorganisms [17].
  • The same study found two common problems in probiotic supplements: low concentration of viable cells and the presence of undesired (potentially harmful) organisms [17].
  • Another study found only half of the probiotics examined had the specific strain listed on the label [18].
  • 43% of the probiotics in another study contained less than half the amount of probiotics listed on their labels [19].

If a company follows quality assurance practices, a probiotic supplement will meet its label claims and not contain potentially harmful organisms.

Take Probiotics at a Convenient Time

Some would recommend taking probiotics at least two hours before or after antibiotics to reduce the potential for the antibiotic to kill the probiotic you just took. You can do this if you want, but if that makes your medication schedule too complicated, just take them together. You’re better off taking them together than not at all.

What About Probiotic Foods?

One way to add probiotic bacteria to the gut is through diet. A number of fermented foods, such as kefir, kimchi, Lacto-fermented sauerkraut, and many types of yogurt, are rich in probiotics. 

However, as you can see in this chart, it’s difficult to eat enough fermented foods to get a therapeutic dose.

FoodSpeciesAmountEquivalent Dose
SauerkrautLeuconostoc mesenteroides, Lactobacillus brevis, Pediococcus pentosaceus, Lactobacillus plantarum3 billion CFU per cup⅛ capsule Lacto-Bifido Blend Probiotic
Yogurt [20, 21]Lactobacillus acidophilus, Streptococcus thermophilus, Lactobacillus delbrueckii subsp. bulgaricus2.5 billion CFU per cup1/10 capsule Lacto-Bifido Blend Probiotic
Lacto-fermented Pickles [22, 23]Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus brevis1.3 billion CFU per pickle0.05 capsule Lacto-Bifido Blend Probiotic
Kefir [24]Lactobacillus brevis, Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Saccharomyces cerevisiae2.5 billion CFU per cup1/10 capsule Lacto-Bifido Blend Probiotic
Kimchi [25, 26]Weissella koreensis, Lactobacillus sakei, Lactobacillus graminis, Weissella cibaria, Leuconostoc mesenteroides11.5 billion CFU per ½ cup½ capsule Lacto-Bifido Blend Probiotic

If you want to enjoy the benefits of fermented foods, you can eat these as well. However, if you are taking a course of antibiotics, I highly recommend probiotic supplements. 

Taking Probiotics With Antibiotics is Beneficial 

Taking probiotics is a simple and highly effective way to improve your health outcomes when you need to take antibiotics. 

Probiotics can not only help antibiotics be more effective at clearing an infection, but they can significantly reduce the incidence of undesirable side effects of antibiotics, most commonly diarrhea and gut dysbiosis. 

In order to have the most beneficial effects with your antibiotic treatment, follow these simple steps to adding a probiotic:

  • Start a high-quality probiotic as soon as you start antibiotics. 
  • Take the probiotics for about three to four weeks, and once your gut is doing well and you are not having gastrointestinal symptoms, keep on the probiotics for another month to allow your gut to get used to its new microbiome. We’ve found this timeframe to be the most effective with our patients.
  • After a month, you can decrease the dose to find your minimal effective dose for your optimal health outcomes.  

We hope that this article helps you maintain a good gut balance and feel well during your course of antibiotic treatment and after. 

If you have been struggling with the effects of taking antibiotics, especially if you have had repeated or long-term antibiotic treatment and would like individualized help, please contact our clinic.

➕ References
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