Written by Karen Hovav, MD, FAAP | Reviewed by Katie E. Golden, MD
Key takeaways:
- Probiotics can be taken with antibiotics to help decrease the chance of side effects from antibiotics, such as diarrhea or Clostridioides difficile (C. diff) colitis.
- People who are most likely to benefit from taking probiotics with antibiotics are those who are at highest risk of side effects. This includes people who are over 65, are hospitalized, or have a weak immune system.
- The best probiotic strains to take with your antibiotic include Lactobacillus rhamnosus GG (L. rhamnosus GG) and Saccharomyces boulardii (S. boulardii).
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If you’re prescribed an antibiotic, you might be told it’s a good idea to start taking a probiotic as well. But others might tell you the opposite: You should stop using probiotics when you’re taking an antibiotic. So, what does the science say?
It turns out that taking probiotics with antibiotics has some proven benefits. We’ll discuss what the latest research reveals about taking a probiotic with antibiotics.
Why would you take probiotics with your antibiotics?
Probiotics can help prevent side effects of antibiotics. This is because of something called the gut microbiome.
Your digestive system is lined with millions of organisms, mostly bacteria. These “good” bacteria play an important role in digestion, immune support, and overall health.
Antibiotics kill bacteria that cause our most unpleasant infections, like sinusitis or urinary tract infections. But antibiotics don’t discriminate between the bad bacteria causing our infection and the good bacteria in our gut. So, antibiotics can harm the healthy balance of bacteria in our gut. This is why antibiotics often lead to side effects like diarrhea.
But if you take probiotics along with the antibiotics, this may help protect your gut health from these harmful effects.
Does research recommend taking probiotics with antibiotics?
Yes. Research suggests that taking probiotics with antibiotics can have many benefits. The American Gastroenterological Association recommends that children and adults use probiotics when they are being treated with antibiotics. These guidelines also recommend more studies to understand when probiotics are most helpful. Certain groups of people, or people with certain conditions, might benefit the most from probiotics.
Probiotics can help reduce side effects from antibiotics
Many studies have shown that taking probiotics with antibiotics can help prevent antibiotic-associated diarrhea. Up to 35% of people who take an antibiotic experience diarrhea. Taking a probiotic along with an antibiotic can decrease the risk of diarrhea by about 50%. This is true for children as well as adults.
Probiotics can also help lower the chance of developing a more serious side effect of antibiotics, called Clostridioides difficile (C. diff) colitis. C. diff colitis is inflammation in the colon that happens when a bacteria called C. diff grows too much. The most common trigger of this is antibiotics. An analysis of 31 studies found that probiotics can decrease the chance of developing C. diff colitis.
Probiotics make some antibiotics more effective
There is some evidence that probiotics can help make some antibiotic treatments even more effective. Examples include antibiotics for:
- Treatment of Helicobacter pylori (H. pylori): Some studies show that adding probiotics to H. pylori treatment (antibiotics and an acid-blocker) makes it more likely that the treatment will be successful.
- Bacterial vaginosis: Bacterial vaginosis is sometimes treated with antibiotics. And adding probiotics (in the form of a vaginal gel) can lead to a higher rate of recovery.
Probiotics protect overall gut health when taking antibiotics
As noted above, when you take a course of antibiotics, it can change the types of bacteria that line your gut. These effects of antibiotics have been linked to possible increased risk for conditions like diabetes, obesity, and asthma, as well as other chronic conditions.
But probiotics have been found to protect the healthy bacteria in your gut while you’re taking antibiotics. Experts don’t know if probiotics can prevent the chronic conditions that are linked to antibiotics, but it is an area of active research.
Taking probiotics after antibiotics
Taking probiotics after you’ve finished your antibiotics course does not seem to be as helpful. In fact, one study from Israel looked at people who were treated with multiple strains of probiotics after a course of antibiotics. They found it took longer for their gut bacteria to return to normal compared to those who did not take probiotics. But it’s important to note that this was a small study that looked at 21 human volunteers.
Are there any risks to taking probiotics with antibiotics?
For most people, taking probiotics with antibiotics is considered safe. One analysis of 23 studies found no harmful side effects of taking probiotics with antibiotics.
But there have been case reports of probiotics leading to infection in people with weaker immune systems. So, if you are on immune-suppressing medication or have a condition that affects your immune system, it’s best to talk to your healthcare provider before starting a probiotic.
Do antibiotics destroy probiotics?
Some people worry that if they take antibiotics and probiotics at the same time, the antibiotics could destroy the probiotics and make them less effective. There are no good studies that evaluate whether or not this is true. But to be on the safe side, healthcare providers often recommend taking a dose of probiotics 1 to 2 hours after you take your dose of antibiotics.
Who should take probiotics with antibiotics?
You are more likely to benefit from taking probiotics with antibiotics if you are at higher risk of side effects — like diarrhea and C. diff colitis. This includes people who:
- Are over age 65
- Are hospitalized
- Live in a nursing home
- Have a weak immune system
- Have had a C. diff infection in the past
You might also consider taking probiotics if you are treating a condition such as bacterial vaginosis or H. pylori.
But that doesn’t mean you need to be high risk — or have the above conditions — to benefit from probiotics. If you are not sure whether or not you want to take probiotics, your healthcare provider can help you figure out what is best for you.
What is the best probiotic to take with your antibiotic?
There are many types of probiotics out there. And it might seem overwhelming to choose the right one.
The good news is that two specific strains of probiotics have the strongest evidence for benefit when they’re added to antibiotics. Its recommended to take one of these two strains:
- L. rhamnosus GG
- S. boulardii
The bottom line
Many people who take antibiotics worry about the potential side effects, especially when it comes to their gut health. But there are ways to protect your gut microbiome when you are being treated for an infection. Research has shown that taking probiotics along with an antibiotic course can reduce the risk of side effects. This is especially true if you are at a higher risk of conditions like C. diff colitis. And taking probiotics may even make certain antibiotic treatments more effective.
References
Abenavoli, L., et al. (2019). Gut microbiota and obesity: A role for probiotics. Nutrients.
Doron, S., et al. (2015). Risk and safety of probiotics. Clinical Infectious Diseases.
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