Your healthcare provider just prescribed you antibiotics. You are thankful that these life-saving medications exist, and you look forward to resolving the issue you need them for.
Before you leave the office, your healthcare provider mentions that you can take a probiotic with your antibiotic. But why? And how do you know which probiotic to take?
We’ll discuss how antibiotics work and why probiotics may pair well with antibiotics.
Antibiotics are medications that can kill or slow down the growth of bacteria in the body. In the United States, you can only get antibiotics with a prescription from a qualified healthcare provider.
Most antibiotics fall into 6 main groups:
Antibiotics are prescribed for a wide variety of issues caused by bacteria. However, they are typically not used for conditions caused by viruses.
Healthcare providers have become increasingly careful about using antibiotics only when necessary to help prevent antibiotic resistance. The benefits of using antibiotics are weighed against the potential side effects.
The possible side effects of antibiotics can range from mild to very severe. Some common side effects include digestive concerns like nausea and changes in bowel movements.
Antibiotic use can also cause yeast and bacterial imbalances. Additionally, there is a chance of being allergic to certain types of antibiotics, which can cause rashes, itching, or a life-threatening allergic reaction.
Scientists are also finding out that antibiotics may cause imbalances in the gut microbiome. These changes to the gut microbes may have a negative impact on the body.
The gut microbiome, also called the gut microbiota, is the collection of a very large number of microscopic organisms that live in the intestines.
Technically, the term “microbiome” refers to the microorganism and their genes. While “microbiota” only refers to the microbes.
Either way, the microbiome includes a wide variety of organisms such as bacteria, yeast, and viruses. Research has continued to show the role these microbes may play in human health. The gut microbiome has been studied in connection with gut health, immune system support, brain health, and metabolic health.
Scientists are also learning how diet can impact the gut microbiome. The microbes in the gut break down fiber from the diet and make short chain fatty acids (SCFA) as a result. SCFAs, such as butyrate, may have many positive benefits to the gut. This includes supporting gut cells and playing a role in immune health.
Other factors can impact the gut microbiome like age, stress, and certain medications.
Under normal conditions, there should be a balance between the microbes in the gut. The “good” bacteria and microbes help keep the “bad” ones in check. But certain factors may cause some microbes to be suppressed and cause others to overgrow.
As we have already discussed, taking antibiotics can kill off or inhibit bacteria. The problematic bacteria are impacted by a course of antibiotics, but the issue is that the good bacteria can also be killed. This is how antibiotics can cause an imbalance of microbes, or microbial dysbiosis.
Ideally, the gut microbiome should regulate itself and get back into balance, but this is not always the case. Especially with frequent or unnecessary use of antibiotics.
Researchers have also found that the gut microbiome of children does not stabilize until after the first 3 years of life. Children given antibiotics during this critical time were found to have less microbial diversity. More research will be needed to see what impact this may have in the long term.
It’s essential to note that antibiotics should still be used when needed. They are life-saving medications and must be used when recommended by your healthcare provider. But is there a way to take antibiotics without having a big impact on the microbiome?
Probiotics are live microbes that may have a variety of benefits to health. They are found in some fermented foods like yogurt and may be added to certain packaged foods like cereals and smoothies.
Probiotics are also available as dietary supplements in capsule, powder, or liquid forms. Probiotic supplements may contain a variety of different types of bacteria like Lactobacillus or Bifidobacterium. They are also available as yeasts such as Saccharomyces. Research suggests that the benefits of probiotics may depend on the specific strains being used.
Probiotics provide bacteria that can impact the gut microbiome. According to the National Institutes of Health, “[probiotics] help protect your digestive tract from harmful microorganisms, improve your digestion and gut function, and might provide other health benefits as well.” This means that probiotics may help support the microbiome and potentially protect it from imbalance.
Most of the research found that it is generally safe to take probiotics with antibiotics. In fact, this combination is encouraged by an article published in The Journal of Family Practice titled “Prescribing an antibiotic? Pair it with probiotics”.
There are still some questions about whether or not probiotics should be taken away from antibiotics because antibiotics could kill the bacteria in the probiotics. There is not enough evidence to support the best timing of probiotics when taking antibiotics, so work with your healthcare professional on this.
If you are new to taking probiotics, it’s important to review the possible side effects. This is especially true if you are going to start a probiotic with an antibiotic. Both probiotics and antibiotics could potentially cause digestive side effects, so it’s a good idea to choose a probiotic you have tolerated in the past.
While most of the research on taking probiotics with antibiotics is positive, one small study did have a unique outcome.
The participants in the study were all given antibiotics and their microbiomes were tested. They were divided into three different groups and allowed to recover spontaneously without any probiotics (this was the control group),e, another group was provided probiotics (consisting of 11 strains), and the final group was given a fecal microbial transplant (stool transplant). The probiotics were found to take more time for restoring the microbiome in comparison to the other two groups. But the probiotic group had more diversity in their microbiome than both the control and fecal transplant groups. It should be noted that probiotics were only administered for 28 days after the 7 day period of antibiotics so perhaps the supplementation period would need to be longer to see complete microbiome restoration. Interestingly, the fecal transplants led to the fastest restoration of the microbiome.
It’s important to note that this is just one small study. When you look at the full body of evidence, the research shows that taking probiotics with antibiotics is likely helpful overall.
There are a variety of diet, supplement, and lifestyle changes that may be beneficial during or after taking antibiotics. The goal of taking probiotics is to help restore the gut microbiome to optimal balance.
There is also some evidence that probiotics may actually help antibiotics work better.
Research has shown that probiotics may make antibiotics more effective. Probiotics can potentially inhibit certain bacteria and break up the protective films on bacteria (a.k.a. biofilms). This can allow antibiotics to do their job at getting rid of the bad bacteria.
As we have discussed, antibiotics may cause certain side effects related to the digestive system and the microbiome. Probiotics can help support the microbiome and support gut health, when taken with antibiotics.
A systematic review of the evidence found that adding probiotics to antibiotic therapy preserves the diversity of the microbiome. Another review of the data found that in healthy subjects who experienced a microbiome disturbance from antibiotics or other reasons, 83% of them had microbiome recovery after taking probiotics.
Probiotics have been found to be helpful for digestive concerns caused by antibiotics. Another study found that probiotics were also beneficial in children for this purpose.
When taking probiotics with antibiotics, ask your healthcare provider how long they would like you to continue to take the probiotic once you are finished with the antibiotic course.
Much of the research looking at taking probiotics and antibiotics used either a blend of Lactobacillus and Bifidobacterium or Saccharomyces boulardii.
When choosing a probiotic, it’s important to use strains that are supported by research. You should also pick a brand that is third-party tested to ensure that you are actually getting what you pay for.
Antibiotics are only available by prescription and should only be used if prescribed by your healthcare provider. It is also just as important to finish your prescription as instructed.
Given the body of evidence, it appears that it’s likely a good idea to take probiotics whenever you are taking antibiotics. Probiotics (and all medications and dietary supplements you are taking) should always be discussed with your prescribing healthcare provider.
Antibiotics are necessary to prevent potentially life-threatening health concerns. However, they may cause certain side effects like digestive symptoms or disruptions to the gut microbiome. Research supports the use of probiotics to help support the body when taking antibiotics. However, you should always check with your healthcare provider before taking probiotics with antibiotics.