Adding Probiotics to Antibiotics for Better Recovery
Key Takeaways:
- Taking probiotics and antibiotics together is more effective than taking antibiotics alone.
- Taking probiotics with antibiotics reduces antibiotic side effects, such as antibiotic-associated diarrhea.
- Probiotics reduce the risk of additional infections in patients on long-term antibiotic therapy.
- Taking probiotics with antibiotics for SIBO can more than double the treatment success rate.
At times, antibiotics are needed to clear an infection, but many patients worry about possible gut issues that can result from taking antibiotics. Common questions we hear at the clinic are: “Should I be taking probiotics with antibiotics?” and, “If I should, when and how do I take them?”
Few other drugs have saved as many lives as antibiotics have. 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.
The good news is that current research shows that taking probiotics with antibiotics at the same time is a great way to combat these negative side effects and can reduce or resolve antibiotic-associated side effects including diarrhea.
Additionally, when taking antibiotics in the treatment of SIBO (small intestinal bacterial overgrowth) and H. Pylori, adding a probiotic can significantly improve treatment outcomes.
You may have heard that it’s pointless to take probiotics and antibiotics together since the antibiotics will “kill all the good probiotic bacteria.” However, recent studies show that probiotics and antibiotics can actually work together.
Let’s take a look at some of that research now to answer your question, “Can I take probiotics with antibiotics?”
Probiotics Make Antibiotics More Effective
Antibiotics are one of the most important life-saving advances in medicine, and recent studies show that antibiotics are even more effective when probiotics are added to the treatment plan.
Probiotics combined with antibiotics improve results in cases of SIBO, H. pylori, and other gut issues:
- A meta-analysis of multiple studies that include more than 20,000 patients with H. pylori infections, showed that patients who took probiotics and antibiotics together had better results than patients who only took antibiotics (Wang et al. 2017).
- In patients with SIBO, one study showed that those taking the probiotic S. boulardii and the antibiotic metronidazole combined were more effective at eradicating SIBO when compared to those taking metronidazole alone (García-Collinot et al. 2020).
- Glucose breath tests were normalized for 13 out of 15 patients with both SIBO and Crohn’s disease when probiotics and antibiotics were used together (Greco et al. 2015).
- In patients with hydrogen SIBO who have not responded to antibiotics for treatment, probiotics have been found to be a possible helpful addition to treatment (Nickles et al. 2021).
- One meta-analysis of randomized clinical trials including about 6,000 patients with H. pylori infections found that adding probiotics to antibiotic therapy increased the eradication rate of harmful bacteria by about 10% (Zhang et al. 2020).
Overall, probiotics are a safe and, often, effective addition to a treatment plan and can improve treatment results for bacterial infections.
Probiotics Reduce Antibiotic Side Effects
Many of our patients report that when they have taken antibiotics, they often had adverse effects such as diarrhea, yeast infections, or gastrointestinal pain. This happens in some people because most antibiotics are broad-spectrum, meaning they kill off both beneficial bacteria and harmful bacteria.
A balance of good and bad bacteria keeps overgrowths of bacteria at bay, such as in the case of a yeast infection where yeast overgrows rather than remaining in balance (Yoon and Yoon 2018). A healthy balance of gut bacteria also helps us properly digest food and contributes to the rate of digestion. When the good bacteria is killed off, we may get undesired side-effects such as diarrhea, yeast infections, decreased immune function, and systemic inflammation (Feng et al. 2019).
These antibiotic side effects can last long after finishing a course of antibiotics. Probiotics help not only during a course of antibiotics, but after as well, by restoring balance to the gut microbiome.
Let’s look at a few examples of how probiotics help decrease antibiotic side effects:
Probiotics Correct Dysbiosis Caused by Antibiotics
A systematic review of 63 trials looking at the use of probiotics for gut dysbiosis found that in healthy individuals, 83% of people saw a recovery of the gut microbiome after taking probiotics, such as Lactobacillus acidophilus and Saccharomyces boulardii [5].
When looking at how well probiotics help resolve the overgrowth of pathogenic bacteria, like in the case of yeast, more research needs to be done. However, probiotics are shown to generally recover the microbiome after antibiotic use (Jung et al. 2013, Cai et al. 2018).
Probiotics Resolve Antibiotic-Associated Diarrhea
Antibiotic-associated diarrhea is one of the most common and painful side effects of antibiotic therapy and is also caused by gut dysbiosis. This imbalance in the gut also impairs normal gut function such as proper digestion and flow of food through the intestinal tract, which results in diarrhea (Barbut and Meynard 2002).
The good news is that many meta-analyses of using probiotics with antibiotics found that probiotics help prevent and treat antibiotic-associated diarrhea:
- The risk of getting antibiotic-associated diarrhea was decreased by 37% when taking probiotics. That increased to a 46% reduced risk with a higher dose of probiotics. The Bifidobacteria and Lactobacillus probiotic species were particularly helpful at reducing risk (Goodman et al. 2021).
- Higher doses of probiotics were effective at preventing diarrhea in children taking antibiotics. For children who still got diarrhea, the duration of the diarrhea was decreased by a day while on probiotics (Guo et al. 2019).
- When treating H. pylori, adding probiotics with antibiotics for longer than 10 days reduced gastrointestinal side effects such as diarrhea, vomiting/nausea, and abdominal pain (Zhang et al. 2020).
Probiotic strains from all three categories of probiotics were used in these studies. These categories are Lactobacillus, Bifidobacteria, Saccharomyces boulardii, and soil-based Bacillus strains (Hempel et al. 2012, Zhang et al. 2020, Guo et al. 2019, Goodman et al. 2021). This means that any probiotic strain you choose will most likely be helpful in your treatment plan.
Clostridium Difficile Infections
If you have ever been in the hospital, you have probably heard about the risks of getting a C. diff infection. This infection often happens when a disruption in the gut microbiome, such as in the case of long-term use of antibiotics in a hospital, allows the growth of C. difficile.
C. difficile infections can lead to life-threatening diarrhea and colon inflammation and are often hard to eradicate. However, researchers have found the use of probiotics, in particular the strain Lactobacillus casei, to be a helpful and safe prevention strategy for Clostridium difficile infections (Ma et al. 2020).
For adults and children in the hospital taking two or more antibiotics, researchers recommend adding probiotics to their treatment plan [7, 8].
When Shouldn’t Probiotics Be Taken with Antibiotics?
Some people claim that probiotics do not help restore the gut microbiome or resolve antibiotic side effects. So, where are they getting this information from?
It is important to understand that with the plethora of research studies, sometimes studies contradict one another. This is why we have meta-analysis, where we look at multiple studies with a large patient sample size, in order to see if an intervention is helpful. Sometimes people choose to focus on the results of one small research study rather than looking at a meta-analysis.
For example, in the question of whether we can take probiotics with antibiotics, one small study of 21 patients questions the value of taking probiotics and antibiotics together [9]. In this study, only eight patients received probiotic therapy, seven patients received no treatment, and six patients received a fecal transplant. This small study showed that probiotics were less effective at facilitating recovery from antibiotics than no treatment at all. It also found that fecal transplant brought almost full recovery in a matter of days.
However, when we look at a meta-analysis of 63 research trials of around 12,000 participants, researchers found that probiotics are beneficial. Those who took probiotics after antibiotic treatment had 48% less antibiotic-associated diarrhea after taking probiotics [10].
In the case of taking probiotics with antibiotics, large meta-analyses of data show that probiotics are beneficial.
How to Combine Probiotics with Antibiotics
Due to the vast benefits we have seen here, I highly recommend taking probiotics with antibiotics. I like to try and make treatment options as simple and effective as possible so for that reason, I recommend these three principles:
- When taking antibiotics, take probiotics as early as possible during your course. Researchers show that this is best for decreasing antibiotic side effects such as antibiotic-associated diarrhea (Liao et al. 2021, Langella and Chatel 2019).
- Take probiotics at a convenient time. You may have heard the advice to take probiotics at least two hours before or after taking antibiotics, to reduce the potential for the antibiotic to kill the probiotic. You can do this if you want, but if that makes your medication schedule too complicated, just take them together. You are better off taking them together than not at all.
- Use high-quality probiotics. Different species of probiotics were all found to be helpful when used with antibiotics, indicating that, in most cases, any strain you choose will be beneficial. At the same time, some people need multiple strains of probiotics for gut healing. You also want to check that the company has quality control measures in place. In laboratory testing, many probiotics have tested to be too low in microbes to be beneficial and/or the probiotic does not contain the strains the label claims.
Let’s take a closer look at using probiotics to get the most from your regimen when taking antibiotics.
All Types of Probiotics Are Likely to Help
Almost all probiotics can be categorized into one of three categories: Lacto-bifido blend, Saccharomyces boulardii, and soil-based probiotics (Fleishman MS RDN n.d.). In many of the studies of using probiotics with antibiotics, Lactobacillus/Bifidobacterium blends and Saccharomyces boulardii happen to be the two categories of probiotics that are used most often, and soil-based less often. One very large meta-analysis found no difference in results across the three probiotic categories in improving outcomes while taking antibiotics [12]. So, whichever type of probiotic you use is likely to be helpful here.
What about Probiotic Quality?
You may have heard that because dietary supplements are not all that well regulated, it can be hard to know if you are getting an effective probiotic. In fact, investigations into probiotic quality have found that many probiotic supplements did not have a high enough concentration of viable cells (meaning you do not get enough of the probiotic to be effective,) and they contained potentially harmful organisms [13]. One study even found that only half of the probiotics studied contained the strain listed on the label [14].
Check with a supplement company to see if it follows quality assurance practices to make sure you get an effective probiotic.
Probiotic Protocol
The difference between success and failure with probiotics often comes down to whether you establish balance in your gut microbiome.
Many people don’t seem to achieve this balance with just one strain of probiotic. Some lucky people do, but for many, one probiotic won’t suffice. After many years of trying different approaches, I’ve found using this multi-strain probiotic protocol to be most effective:
- Choose a high quality probiotic formula and begin to take your probiotics as directed on the bottle.
- Monitor your symptoms for at least 3-4 weeks, until your improvements have plateaued.
- Once your improvements have stabilized (you’ve plateaued), keep using the probiotics for about a month more. This will let your gut and immune system acclimate to these improvements.
- You can then reduce your dose in order to find your minimal effective dose. Stay on the minimal effective dose for as long as you are feeling well.
What About Probiotic Foods?
With the popularity of probiotic foods such as kombucha, kefir, and tempeh, you may wonder if you can just use probiotic foods.
Probiotic foods are great for our general health. However, as this chart shows, it is difficult to eat enough fermented foods to get a high enough dose to be used as a treatment.
| Food | Species | Amount | Equivalent Dose |
| Sauerkraut (Rezac et al. 2018) | Leuconostoc mesenteroides, Lactobacillus brevis,Pediococcus pentosaceus, Lactobacillus plantarum | 14.2 billion CFU per cup | 1/2 capsule Lacto-Bifido Blend Probiotic |
| Yogurt [1, 2] | Lactobacillus acidophilus, Streptococcus thermophilus,Lactobacillus delbrueckii subsp. bulgaricus | 2.5 billion CFU per cup | 1/10 capsule Lacto-Bifido Blend Probiotic |
| Lacto-fermented Pickles [3, 4] | Lactobacillus casei, Lactobacillus rhamnosus,Lactobacillus plantarum, Lactobacillus brevis | 1.3 billion CFU per pickle | 0.05 capsule Lacto-Bifido Blend Probiotic |
| Kefir [5] | Lactobacillus brevis, Lactobacillus acidophilus,Lactobacillus casei, Lactococcus lactis,Saccharomyces cerevisiae | 2.5 billion CFU per cup | 1/10 capsule Lacto-Bifido Blend Probiotic |
| Kimchi [6, 7] | Weissella koreensis, Lactobacillus sakei,Lactobacillus graminis, Weissella cibaria,Leuconostoc mesenteroides | 11.5 billion CFU per ½ cup | ½ capsule Lacto-Bifido Blend Probiotic |
Enjoy all the fermented foods you like, but when you are on a course of antibiotics, I highly recommend using a probiotic supplement.
Can I Take Probiotics with Antibiotics? Yes!
Taking antibiotics, when needed, is not something to fear, especially now that we know how helpful adding probiotics to a course of antibiotics can be.
Probiotics can not only make your antibiotics more effective, increasing healing, but they can also decrease the risk or duration of unpleasant antibiotic side effects.
To make adding probiotics to antibiotics as easy as possible, take your probiotics when it is convenient for you and you will remember to take it. You can use triple-therapy probiotics in order to make sure you get each strain of probiotic for the most effectiveness. Take them for at least a month, until you can find the long-term dose that works for you.
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.
I hope that this article has helped you feel more comfortable if you have been prescribed a round of antibiotics. With probiotics, it is possible to decrease antibiotic side effects and maintain a healthy gut microbiome during and after your course of antibiotic treatment.
