Key takeaways:
There’s some evidence that taking probiotics with antibiotics may decrease the chance of side effects, such as diarrhea or Clostridioides difficile (C. diff) colitis.
People who are most likely to benefit from taking probiotics with antibiotics are those at highest risk of side effects. This includes adults over age 65, people with weakened immune systems, and those who are hospitalized.
The best probiotic strains to take with your antibiotic include Lactobacillus rhamnosus GG (L. rhamnosus GG) and Saccharomyces boulardii (S. boulardii).
If you’re prescribed an antibiotic, you might wonder whether you should also start taking a probiotic. Some people say probiotics can help protect your microbiome. Others might recommend stopping probiotics when you’re taking an antibiotic.
Here’s what the latest research says about taking probiotics with antibiotics.
Can you take probiotics with antibiotics?
Yes, you can take probiotics with antibiotics. In fact, some research suggests that doing so may help prevent some of the side effects of antibiotics.
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People often take probiotics with antibiotics to help protect their gut microbiome. Your digestive system is lined with millions of organisms, mostly bacteria. These are “good” bacteria, which play an important role in digestion, immune support, and overall health.
Antibiotics kill bacteria that cause 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. As a result, antibiotics can harm the balance of good bacteria in your gut. This is why antibiotics often lead to side effects like diarrhea.
Taking probiotics with antibiotics may help protect your gut from these harmful effects.
Does research recommend taking probiotics with antibiotics?
Taking probiotics with antibiotics can have many benefits. The American Gastroenterological Association (AGA) recommends that both children and adults take probiotics while taking antibiotics. But certain groups of people may benefit more than others, especially those with certain conditions.
Probiotics can help reduce side effects from antibiotics
Studies show that taking probiotics with antibiotics can help prevent antibiotic-associated diarrhea. Up to 35% of people who take antibiotics experience diarrhea. Taking a probiotic at the same time may decrease this risk by about 50%. This is true for both children and adults.
Probiotics can also help lower the risk of developing Clostridioides difficile (C. diff) colitis, a more serious side effect of antibiotics. C. diff colitis is inflammation in the colon caused by too much C. diff bacteria. Antibiotics are the most common trigger. An analysis of 31 studies found that probiotics can decrease the risk of developing C. diff colitis. So, taking probiotics with antibiotics may be especially helpful for people at high risk of side effects. (We’ll go into this a little more below.)
Probiotics make some antibiotics more effective
There’s some evidence that probiotics can help make some antibiotic treatments even more effective. For example:
Helicobacter pylori (H. pylori): Some studies show that adding probiotics to H. pylori treatment (which includes antibiotics and an acid-blocking medicine) 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) may lead to a higher rate of recovery.
Probiotics protect overall gut health when taking antibiotics
Antibiotics can change the types of bacteria that line your gut. These effects have been linked to a possible increased risk for conditions like diabetes, asthma, and obesity.
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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 can you take probiotics with antibiotics?
If you’re going to take probiotics with antibiotics, research suggests taking them at the same time. Taking probiotics after you finish 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.
It’s important to note that this was a small study with only 21 human volunteers, so more research is needed.
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 from taking probiotics with antibiotics.
But there have been case reports of infections linked to probiotic use in people with weakened immune systems. So, if you’re on medications that suppress your immune system or have a condition that affects your immune system, 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 probiotics less effective. There are no good studies that clearly answer this question. To be safe, healthcare professionals often recommend taking probiotics 1 to 2 hours after your antibiotic dose.
Why don’t doctors prescribe probiotics with antibiotics?
Research on the benefits of combining probiotics with antibiotics is still controversial. Some studies show little or no effect on your gut microbiome. Because of this, healthcare professionals don’t recommend this for everyone.
Probiotics can also be costly and may have side effects or risks of their own. Until experts have a better idea who will benefit, it’s best 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 weakened 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 infection.
But that doesn’t mean you need to be high risk — or have the above conditions — to benefit from probiotics.
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.
Two specific strains of probiotics have the strongest evidence for benefits when taken with antibiotics:
Lactobacillus rhamnosus GG (L. rhamnosus GG)
Saccharomyces boulardii (S. boulardii)
Frequently asked questions
Foods and supplements that contain calcium or iron can interfere with the absorption of two main types of antibiotics:
Fluroquinolones: ciprofloxacin (Cipro), levofloxacin, and moxifloxacin (Avelox)
Tetracyclines: tetracycline, doxycycline (Vibramycin), and minocycline (Minocin)
It’s best to wait at least 2 hours after taking your antibiotic before eating foods high in iron or calcium.
You should avoid lying down for 30 to 60 minutes after taking antibiotics, especially doxycycline. Staying upright helps prevent the pill from getting caught in your esophagus. If this happens, it can irritate or erode the lining of your esophagus and lead to a serious condition called esophagitis.
Foods and supplements that contain calcium or iron can interfere with the absorption of two main types of antibiotics:
Fluroquinolones: ciprofloxacin (Cipro), levofloxacin, and moxifloxacin (Avelox)
Tetracyclines: tetracycline, doxycycline (Vibramycin), and minocycline (Minocin)
It’s best to wait at least 2 hours after taking your antibiotic before eating foods high in iron or calcium.
You should avoid lying down for 30 to 60 minutes after taking antibiotics, especially doxycycline. Staying upright helps prevent the pill from getting caught in your esophagus. If this happens, it can irritate or erode the lining of your esophagus and lead to a serious condition called esophagitis.
The bottom line
Many people who take antibiotics worry about potential side effects, especially when it comes to their gut health. But there are ways to protect your gut microbiome during treatment. Research has shown that taking probiotics along with an antibiotic course can reduce the risk of side effects. This is especially true if you’re at a higher risk for conditions like C. diff colitis. Taking probiotics may even make certain antibiotic treatments more effective.
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References
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