Can you take probiotics with antibiotics?

In this article:

• Antibiotics and gut health
• Should you take probiotics with antibiotics?
• When to take probiotics
• Which probiotics to take
• Probiotic risks
• Probiotic-rich foods

In this article

• Antibiotics and gut health
• Should you take probiotics with antibiotics?
• When to take probiotics
• Which probiotics to take
• Probiotic risks
• Probiotic-rich foods

Antibiotics play a critical role in killing bad bacteria. However, as they destroy infections, they can also cause collateral damage by killing the good gut bacteria that support immune system function. This could result in diarrhea after starting treatment, which can continue for weeks after you stop taking the medicine.

You need the health benefits of antibiotic treatment, but, of course, you don’t want the nasty stomach side effects. The answer might be found in probiotics, which are live microorganisms that boost gut health. Read on if you’re wondering about the best way to take probiotics with antibiotics.

The impact of antibiotics on gut health

Antibiotics are medications that fight bacterial infections. They work in one of two ways: either by destroying a specific type of bacteria or preventing its growth. Antibiotics achieve these results in several ways. They are usually taken orally but can also be used topically for skin infections or administered intravenously for more serious and systemic bacterial infections.

Because they fight bacteria, antibiotics won’t work for viral infections. They should only be taken when necessary to avoid antibiotic resistance, which happens when bacteria adapt to protect themselves from being destroyed by antibiotics.

Why do antibiotics upset your stomach?

Researchers have identified a diverse community of about 100 trillion microorganisms and their genetic material that inhabit the gastrointestinal tract (GI tract). This is known as the gut microbiome or gut flora. Most of these microorganisms are bacteria but also include fungi, viruses, and protozoa (a type of parasite). Together, they play an important role in human health, affecting many bodily processes, including digestion, synthesis of nutrients, and the regulation of metabolism, body weight, and the immune system. It also affects brain function and mood.

The microbiome is made up of both beneficial and harmful microbes. The good guys work in symbiosis with the human body, while the bad microbes can promote disease. Usually, the good and bad microbes comprising the microbiome live in balance and can coexist without any issues.

Antibiotic use changes the balance in the gut microbiome, which may result in a decrease in the healthy bacteria and an increase in the harmful bacteria, explains Lawrence Hoberman, MD, a board-certified gastroenterologist.

Antibiotic use can have negative effects on the microbiome, such as reduced species diversity and altered metabolic activity. What’s more, antibiotic use can cause antibiotic-related complications such as nausea, diarrhea, and Clostridioides difficile infections (also known as C. difficile or C. diff). One study found the antibiotics-diarrhea connection impacts between 5% and 39% of patients, depending on which antibiotic they take.

Clostridioides difficile is a bad bacteria that is allowed to grow when antibiotics kill the good bacteria. A C diff infection can cause anything from chronic diarrhea to life-threatening colitis with sepsis. It is diagnosed by a stool test and treated with the oral antibiotics vancomycin or fidaxomicin.

Should you take probiotics with antibiotics?

If your stomach is upset when taking antibiotics, you likely want to find a way to feel better. Probiotics could be the answer.

Research shows that probiotic use can curb digestion problems. Taking probiotics during the entire course of antibiotic treatment is an effective way to reduce side effects like antibiotic-associated diarrhea (AAD). A meta-analysis of 34 studies found that probiotics reduce instances of AAD by 52%. Probiotics replenish the beneficial bacteria in the gut to prevent disrupting the microbiome’s balance.

In addition to diminishing antibiotics’ digestive side effects, the use of probiotics can make antibiotics more effective. One study found that among 6,000 people with H. pylori infections, supplementing antibiotic therapy with probiotics increased the eradication rate by about 10%, an effect supported by more recent research.

This is why doctors often recommend taking probiotics when you’ve been prescribed antibiotics—just be sure to space out when you take them, so you’re not taking a dose of antibiotic at the same time as a probiotic supplement.

When to take probiotics with antibiotics

Start taking probiotics daily on the same day you begin your antibiotics, at least two hours apart. “By waiting two hours, the probiotic or antibiotic level is low in the intestines,” Dr. Hoberman says. “It doesn’t make any difference which is taken first, as long as it’s separated by two hours.”

The specific dosage will vary depending on the product you use. Still, a typical probiotic dose ranges between 10 to 20 billion colony-forming units per day for adults and 5-10 billion colony-forming units per day for children.

Continue taking probiotics for at least a week after your course of antibiotics ends.

Which probiotics should you take with antibiotics?

Your pharmacy probably has shelves filled with different bottles of probiotic supplements, which can make it difficult to know which one to take. Common strains include Lactobacillus, Saccharomyces boulardii, and Acidophilis. The American Family Physician says to look for the three D’s: diversity, dose, and delivery.

Diversity

The label on a bottle of probiotics will tell you which strains of bacteria the capsules contain. Look for probiotics that have five to 10 different strains. The most widely studied types of probiotics include Lactobacillus acidophilus and Bifidobacterium species. These strains of probiotics have been shown in more studies to help stabilize the microbiome and keep it healthy compared to other probiotic strains. If you’re considering adding a probiotic supplement to your daily regimen, consult your provider first about what type of diversity you need.

Dose

The active microbiota in a probiotic is measured in colony-forming units, or CFUs. Many providers recommend a dose of 10 billion CFUs or higher.

Delivery

Probiotic supplements come in various forms, including capsules, powders, gel caps, gummies, and liquids. The best kind for you will be the kind that you tolerate best.

You can ask your pharmacist for a recommendation on the best probiotic that fits these three criteria.

Are there any risks to taking probiotics with antibiotics?

For healthy individuals, there are no major risks or adverse effects of taking probiotics with antibiotics. However, research indicates that probiotics may increase infection risk in immunocompromised patients and may cause gastrointestinal side effects like gas, bloating, and constipation. Consult a healthcare provider for personalized advice about using probiotics.

Although probiotics don’t fight against antibiotics, it’s essential to time your probiotic supplementation around your antibiotics dose appropriately. If you take antibiotics at the same time as probiotics, the latter will be less effective. That’s because antibiotics are designed to kill or inhibit all good and bad bacteria. Taking probiotics two hours before or after your antibiotic dose is best. This way, they can help restore the microbiome without antibiotic interference.

While some healthcare professionals prescribe probiotics with antibiotics, not all do. That’s likely because research isn’t universally strong regarding the benefits of probiotics in restoring gut flora after antibiotics. For example, a 2023 research review and meta-analysis found that probiotic supplementation during antibiotic therapy was not clinically beneficial for gut microbiome diversity. Still, that’s not to say probiotics have no impact, as they are useful for the prevention of antibiotic-associated diarrhea. Your prescribing healthcare provider can discuss the potential benefits of probiotics with you.

What you should eat during antibiotic therapy

Don’t stop with supplements alone—eating foods that are rich in probiotics and prebiotics can help your stomach stay strong and is an alternative approach to probiotic supplements. Prebiotics are the high-fiber foods that your body can’t digest. As they pass through your digestive tract, they feed the probiotics living there and stimulate their growth. In other words, they help the good bacteria (the probiotics) in your gut flourish and make them more effective.

When you’re taking antibiotics, it’s a good idea to eat a diet that’s rich in both prebiotics and probiotics.

Try eating prebiotic-rich foods, which can help to increase beneficial bacteria like Bifidobacteria and Lactobacillus, such as:

• Leafy bitter greens, like dandelion greens, seaweed, and spinach
• Onions, garlic, and leeks
• Asparagus
• Bananas
• Apples
• Barley
• Oats
• Cocoa
• Flaxseeds
• Roots, like chicory root and jicama root
• Jerusalem artichoke

Then, add probiotic-rich foods to your diet, such as:

• Fermented foods like raw, unpasteurized sauerkraut (pasteurization kills the live and active bacteria), tempeh, and kimchi
• Miso
• Yogurt (with live and active cultures), kefir, and buttermilk (traditional, not cultured)
• Kombucha
• Pickles (cucumbers pickled in salty water and fermented; pickles made with vinegar do not have probiotic effects)

If you are trying to incorporate pre- and probiotic foods into your diet, be sure to double-check with your healthcare provider or pharmacist about foods and drinks that may interfere with your antibiotics.