Should You Take Probiotics With Antibiotics?

There is no denying the benefits of antibiotics.

If you’ve ever suffered from a bad bacterial infection you’re likely to have a serious amount of appreciation for them.

However, they certainly don’t come without their side effects.

Antibiotics have been shown to disrupt the delicate balance of our gut microbiome causing dysbiosis, which can result in digestive upset along with other issues. (Source)

Antibiotics

Antibiotics are a type of medication that is used to treat bacterial infections.

They work by killing the invading bacteria that is causing the infection.

But antibiotics don’t differentiate between this disease-causing bacteria and the beneficial bacteria that live in our gut and so can end up killing both. (Source)

Maintaining a good level of beneficial gut bacteria is associated not just with better overall gut health but also better health in general.

The development of constipation, diarrhea, and vaginal thrush that is sometimes experienced with antibiotics is thought to be linked to the disruption in gut bacteria seen with antibiotic use.

Overprescription of antibiotics or the unnecessary prescription of antibiotics, which our founder Adam Wright experienced when he first became ill with Chronic Fatigue Syndrome and was misdiagnosed, can drastically change the amount and types of bacteria within the gut as well as contribute to antibiotic resistance, meaning the antibiotics are no longer effective at fighting disease-causing bacteria. (Source)

Related: Check out best greens for gut health

Antibiotics And Probiotics

When prescribed an antibiotic, many people nowadays choose to also supplement with probiotics.

Many doctors and pharmacists may even recommend this to patients.

The reasoning behind this is that probiotics are thought to restore the natural balance of bacteria in your gut which may be disturbed by the course of antibiotics.

Antibiotic-Associated Diarrhea

The beneficial effect of antibiotics can be seen most clearly in patients who suffer from antibiotic-associated diarrhea (ADD).

AAD is one of the most common side effects associated with antibiotic therapy and results from the disruption of the gut microbiome by antibiotics. (Source)

Research shows that probiotics work well in preventing and treating AAD. (Source)

A higher dose of probiotics has been shown to be more effective, with Lactobacillus and Bifidobacteria being particularly helpful. (Source)

Clostridium Difficile

Clostridium difficile is a particular form of AAD that occurs when changes in the balance of bacteria in the gut (due to antibiotic use) causes C. difficile bacteria, which naturally live in your gut, to infect the bowel.

This can manifest as chronic diarrhea, or in severe cases, colitis.

Research suggests that probiotics are both safe and effective for preventing C. difficile-associated diarrhea. (Source)

Dysbiosis

Due to probiotics reducing the gastrointestinal side effects of antibiotics, as seen in AAD and C. difficile patients, it was assumed that probiotics were also effective at restoring the natural balance of the gut microbiome following dysbiosis due to antibiotic use.

However, research on this was sparse until recently.

In 2018, one study found that in a group of patients given probiotics alongside their antibiotic treatment, the gut microbiome actually took longer to return to normal than in the group of patients who didn’t receive probiotics. (Source)

These findings were surprising and received attention from the media, leading to confusion around the use of probiotics with antibiotics.

However, it is important to note that this was a single study carried out on just 21 patients.

A recent systematic review, published in 2022, that took into account a total of 29 studies, concluded that probiotics do seem to preserve the diversity of bacteria in the gut during antibiotic interventions and ameliorate the negative effects of antibiotics on the gut microbiome and digestive system. (Source)

Taking Probiotics With Antibiotics

When it comes to taking probiotics with antibiotics, the research is undeniably positive.

However, when it comes to dosage, frequency, length of intervention, and bacterial composition that would be most beneficial for probiotic interventions during antibiotic treatment research is lacking and so, definitive guidance is not currently available.

If you do decide to take probiotics with a course of antibiotics here is some information that may be useful:

• Probiotics won’t affect the efficacy of antibiotics
  There is no suggestion in current research that probiotics interfere with the action of antibiotics in any way.
• Antibiotics can kill probiotics
  Unfortunately, many strains of probiotics can be killed by antibiotic medication so it is important to choose a probiotic that is antibiotic resistant. Opt for a strain of probiotic that has been proven to survive alongside antibiotics and exert beneficial effects.
• Continue taking the probiotics after the course of antibiotics
  The beneficial effects of probiotics on antibiotic disturbances have mostly been reported when probiotics are taken as early as possible into the course of antibiotics and then continually taken for about a week after the course.
• The best time to take probiotics may change slightly
  Some probiotics can be taken at the same time as antibiotics, usually in the morning with food. However, generally, it is recommended to take probiotics two hours after taking an antibiotic, as after this time the probiotic bacteria have a greater chance of reaching the gut alive.
• Consider a prebiotic after your antibiotic
  Prebiotics are foods that feed the good bacteria in the gut and are often found in high-fiber foods as well as prebiotic supplements. Prebiotic foods and supplements support the growth of beneficial bacteria in the gut, which can be particularly helpful after a course of antibiotics, alongside probiotics. Prebiotics have been seen to slow the rate of digestion however, which can slow the rate at which medicines are absorbed too. So it’s best to wait until after you’ve finished your course of antibiotics before loading up on the prebiotics.

Always follow the advice of a doctor or pharmacist when beginning to supplement with probiotics as guidance can vary depending on the type of antibiotic and the strain of probiotics.

Conclusion: Probiotics vs Antibiotics?

Antibiotics and probiotics are commonly pitted against each other, with people asking whether they should be taking one or the other.

Although taking probiotics regularly has been linked to having a positive effect on immune function, which in turn may lead to a reduced need for antibiotics due to a lower risk of infection, when a serious bacterial infection does take hold, antibiotics are vital.

And when taking antibiotics, probiotics have been shown to be useful in reducing negative side effects.

So really, probiotics and antibiotics aren’t opposing each other but rather go hand in hand, both working to keep you healthy!