Should You Take Probiotics With Antibiotics? Here’s What the Research Shows

If you’re prescribed an antibiotic, you might wonder if it’s a good idea to start taking a probiotic as well. Others might recommend stopping probiotic use when you’re taking an antibiotic. So, what does the science say? 

It turns out research suggests taking probiotics with antibiotics may have some benefits. But it also has some limitations. We’ll discuss what the latest research reveals about taking a probiotic with antibiotics. 

Why would you take probiotics with antibiotics?

Probiotics may 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 your most unpleasant infections, like sinusitis or urinary tract infections (UTIs). But antibiotics don’t discriminate between the bad bacteria causing your infection and the good bacteria in your gut. So antibiotics can harm the healthy balance of bacteria in your gut. More specifically, antibiotics can decrease the healthy diversity of different microbes in your 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. 

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Does research recommend taking probiotics with antibiotics?

Research suggests that taking probiotics with antibiotics can have many benefits. The American Gastroenterological Association (AGA) recommends that both children and adults use probiotics when being treated with antibiotics. But certain groups of people or those with certain conditions may benefit more. 

Probiotics can help reduce side effects from antibiotics 

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 with an antibiotic may decrease this risk by about 50%. This is true for both children and adults. 

Probiotics can also help lower the chance of developing Clostridioides difficile (C. diff) colitis, a more serious side effect of antibiotics. C. diff colitis is inflammation in the colon caused by an overgrowth of C. diff. 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. 

Given these findings, the AGA recommends probiotics with antibiotics as potentially more beneficial for people at high risk of side effects. (We’ll go into this a little more below.)

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Probiotics make some antibiotics more effective

There’s some evidence that probiotics can help make some antibiotic treatments even more effective. For example:

• 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. 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, antibiotics 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, asthma, and other chronic conditions. These effects of antibiotics have also been linked to having a larger body size. 

Some evidence suggests that probiotics can protect the healthy bacteria in your gut while you’re taking antibiotics. But another review of several studies didn’t find any preservation of healthy gut bacteria in people who took probiotics with antibiotics. So this is still an area of active research. 

When should you take probiotics with antibiotics?

If you’re going to take probiotics with antibiotics, the research suggests that you should take them at the same time. Taking probiotics after finishing your antibiotics course doesn’t 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 didn’t 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. An analysis of 23 studies found no harmful side effects of taking probiotics with antibiotics. 

But there have been case reports of probiotics leading to infections in people with weakened immune systems. So, if you’re on immunosuppressive medication or have a condition that affects your immune system, it’s best to talk to your healthcare professional before starting a probiotic. 

Do antibiotics destroy probiotics? 

Some people worry that taking antibiotics and probiotics at the same time could make the probiotics less effective. There are no good studies that evaluate whether or not this is true. But to be on the safe side, healthcare professionals often recommend taking probiotics 1 to 2 hours after antibiotics.

Why don’t doctors prescribe probiotics with antibiotics?

Research on the benefits of combining probiotics with antibiotics is still controversial. Some studies suggest this combination doesn’t have any significant impact on your gut microbiome. So, it doesn’t make sense for healthcare professionals to prescribe this for everyone. Plus, probiotics can be costly and have side effects and risks of their own. Until experts have a better idea who will benefit, it makes more sense for people and their care team to weigh the pros and cons together.

Who should take probiotics with antibiotics?

You’re more likely to benefit from taking probiotics with antibiotics if you’re 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’re treating conditions 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’re not sure whether to take probiotics, your prescriber can help you figure out what’s 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 added to antibiotics. It’s recommended to take one of these two strains: 

• L. rhamnosus GG

• S. boulardii

Why trust our experts?

Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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